To clamp or not to clamp

[FLGAZRN]

We have negative pressure end caps for central lines.

Then we have positive pressure end caps for our PICC lines.

What current research do you all have in regards to clamping lines with certain end caps??

What are your policies on your units?

[Melina]

I was wondering the same thing on my last shift! It wasn't covered in our policy, so I looked it up. Depending on the manufacturer, some end caps do not require clamping to function. Clamping between uses is recommended, though, because the end caps could loosen, making patients vulnerable to air embolism,etc.

http://www.carefusion.com/pdf/Infusion/clinical_documentation/white_papers/Clamping_WP_MX2923.pdf

[FLGAZRN]

I was wondering the same thing on my last shift! It wasn't covered in our policy, so I looked it up. Depending on the manufacturer, some end caps do not require clamping to function. Clamping between uses is recommended, though, because the end caps could loosen, making patients vulnerable to air embolism,etc.

http://www.carefusion.com/pdf/Infusion/clinical_documentation/white_papers/Clamping_WP_MX2923.pdf

oo! thank you for that link!!

[SaoirseRN]

We have this same situation. We don't clamp. We flush VERY vigourously in a push-pause pattern and disconnect while still pushing the plunger. Basically you almost want to end up squirting that last ml in your patient's face.

EDIT: Sorry, this applies just to the valved PICCs. Our central lines are clamped and heparinized.

[IVRUS, BSN, RN]

Whether to clamp before removing your syringe, or clamp after the syringe is removed really depends on what type of injection cap is at the end of your IV catheter.

There are NOT caps which are "positive pressure", but rather the caps are: Positive Displacement design, Negative displacement, and Neutral devices.

The Positive Displacement caps like the CLC2000 and the Maxclear, are devices that should be used in this fashion: Flush the device, leaving approx. 1 cc of NS in the syringe and then disconnect your syringe, wait 5 seconds then clamp.

The reason for this procedure is that once you remove your syringe, fluid is forced out the end of the IV catheter which then disallows a blood reflux into the catheter.

The Negative displacement design caps should be used using positive pressure flushing: Flush, and then as you are flushing the last 1/2 cc into the IV catheter, you clamp the IV catheter simultaneously.

Or, if you have a neutral design cap, the flushing sequence is inconsequential.

Hope this helps. Check out the IFU's on each caps web page to assess its type.