What is the correct procedure for flushing a PICC line that has TPN running?

[ccrunner72000]

Hello,

I am a nursing student who recently had a patient with TPN running through their PICC line. I was wondering what is the correct procedure for flushing the PICC lumen that has the TPN line connected to it. Please advise.

Thank you.

[JustBeachyNurse, LPN]

What is the facility protocol? What were you told?

[Pepper The Cat, BSN, RN]

Why would you flush a PICC that has something being run through it? If it is being used, there should be no reason to flush.

[ccrunner72000]

It was a triple lumen PICC and I had to pause the TPN so that blood could be drawn for labs. Wouldn't I need to flush the line so that the TPN would not mix with the blood sample and distort the lab results?

[JustBeachyNurse, LPN]

Not exactly. Usually with a triple lumen there is a lumen dedicated for blood draws you shouldn't have to stop. & disconnect TPN to draw blood.

You would flush for patency, discard the potential discarded sample, draw, flush.

If you are a student, what did your clinical instructor and primary nurse tell you to do per facility protocol ?

[JustBeachyNurse, LPN]

Here's a sample protocol for blood draws. If multiple lumens you do not disconnect the other fluids whether medication or TPN. It clearly states follow facility/manufacturer protocol. Never use smaller than a 10mL syringe as the pressure created by a smaller syringe can damage the catheter lumens. You did not state specifically what brand, but all manufacturers generally will list recommended protocol in their online resources.

Again as a student this requires direct supervision by a qualified licensed nurse as these catheters are in a major vein and you can cause serious harm for failing to follow protocol.

http://www.iv-therapy.net/pdf/flushing.pdf

[mrsboots87]

Why didnt you ask the nurse who should have been supervising you. In many school, we as students cant even do anything requiring a procedure with a PICC line. So this is definitely something that should be done with your nurse or clinical instructor, who wold have told you how to do it. And lastly, when all else fails, look up your facilities policy and procedures for PICC line blood draws with multiple lumens since that will be the answer that matters.

[SierraBravo]

That is interesting because in NY students are never allowed to even touch a central line, whether they are with their instructor or not. However, I agree with the other posters, go by your facility policy and procedure. If it were me and I had a patient with a triple lumen PICC (never seen more than a double lumen PICC) and I had something infusing into each lumen, I would pause one of the infusions and disconnect the line. I would also pause the other infusions and clamp each port that I was not drawing from. Then I would flush the line with a 10mL NS flush and draw 10mL of blood for my waste. Discard the waste. Then use a 10mL sterile syringe to draw my blood sample and transfer that to my tubes. After I was done with that, I would flush the port with two 10mL NS flushes which checking for blood return in the process, then reconnect the line to the port that was running. Then unclamp the other 2 ports and restart all 3 infusions. Obviously you scrub the hub for 10-15 seconds and let it dry before attaching anything to the port.

[dexm]

It was a triple lumen PICC and I had to pause the TPN so that blood could be drawn for labs. Wouldn't I need to flush the line so that the TPN would not mix with the blood sample and distort the lab results?

Since there are 2 other ports available, you don't need to disconnect/flush the line unless you absolutely have to draw blood from the port with the TPN infusing. But you do need to pause the TPN when drawing from another port because it will contaminate the results.

[IVRUS, BSN, RN]

"Never use smaller than a 10mL syringe as the pressure created by a smaller syringe can damage the catheter lumens. You did not state specifically what brand, but all manufacturers generally will list recommended protocol in their online resources."

But, JustBeachy, She is asking about withdrawing from a PICC, not administering. With withdraw, smaller syringes should be used as a 10 cc syringe creates too much negeative pressure. Therefore when aspirating for labs, the smaller syringes are better.

When ascertaining patencies and with flushing, then 10 cc syringe barrel or larger is appropriate.

[JustBeachyNurse, LPN]

"Never use smaller than a 10mL syringe as the pressure created by a smaller syringe can damage the catheter lumens. You did not state specifically what brand, but all manufacturers generally will list recommended protocol in their online resources."

But, JustBeachy, She is asking about withdrawing from a PICC, not administering. With withdraw, smaller syringes should be used as a 10 cc syringe creates too much negeative pressure. Therefore when aspirating for labs, the smaller syringes are better.

When ascertaining patencies and with flushing, then 10 cc syringe barrel or larger is appropriate.

She was asking initially about flushing