whats wrong with clamping the PICC??

[Ms.RN]

i work at ltc facility and i had a patient with picc to receive iv vanco. this morning midnight shift nurse couldnt flush picc line because it was plugged. so the morning nurse called doc, sent him to er and came back on my shift. er physician called me and asked me what the problem was i told him becuase his picc was plugged. he said was a line clamped? i said we unclamped it and tried to flush it but there was too much resistance. then er doc told me we should never ever clamp picc line. this is the first time i ever heard of this. since i worked as a nurse, we often clamp either picc line or peripheral line to prevent blood from backflowing after we give medication and flush the line. so does clamping picc line cause line to clog? we clamp it after we flush it with saline.

and second what is your facilitys protocol regarding flushing picc line? if patient is receiving medication like vanco, shouldnt it be flushed with heparin? we use sash protocol by flushing it with saline, med, saline, heparin. how often do you flush the line? thanks for any info.

[Texas Tornado]

yes... I clamp - that is I clamp if there is a clamp. We have several kinds of PICC's and not all of them have clamps. If they do I use it.

We also use SASH unless the pt can't have heparin or unless it is one of the new SOLO PICC's that we sometimes see on the unit these days.

We flush bid at minimum. Usually the line gets flushed much more with meds throughout the day.

I have no idea what the doc was talking about

[4x4country]

we clamp! if it does not have one we were told by pharmamerica pharmacy to add a extenstion. had a inservice on this two weeks ago. Also we were told to flush all ports with minimal 10 mL flush. The pharmacy has per-filled syringes for this. It is in the MAR to sign off also. Hope this helps .

[Virgo_RN, BSN, RN]

Was it a Groshong?

[softstorms]

there are some newer picc lines that you do not clamp, and you do not use heprinflushes on. most of us older nurses do not know about these, but we are learning LOL. Ask questions and learn more.

[patwil73]

If my memory serves correctly there are a few piccs (groshong among them) that usitlize a pressure valve - you push fluid it opens to allow fluid out, you pull back it opens the valve another way to allow blood flow into the line, otherwise it stays neutral neither allowing fluid out or blood in.

That being said, clamping should have no effect on this and wouldn't cause a plugged line. Even the site for groshong only states it reduces the need for clamping, not that clamping is wrong.

The most common cause of plugged lines is not flushing adequately. People have Iv fluids running, clamp the line and discard the fluid instead of flushing to clear anything in the line away, or failure to flush after aspirating blood sufficiently.

Hope this helps

Pat

[Bluehair]

We clamp. Flush Q 12 hours minimum with saline flushes, but we use 2 saline flush syrings (total 20 c) each time.

[Viviana, ASN, RN]

Of course you clamp it. That's what stops the heparin from flowing out of the line.

viv

[queenjean]

Depends upon the type of PICC. Some of our PICCs don't have clamps on them, some do. If there is a clamp on it, it gets clamped. If not, not. Easy.

The flush is dependent upon the type: some are BID et some are q24hr. Oh, I'm lumping ports into this, too.

[IVRUS, BSN, RN]

i work at ltc facility and i had a patient with picc to receive iv vanco. this morning midnight shift nurse couldnt flush picc line because it was plugged. so the morning nurse called doc, sent him to er and came back on my shift. er physician called me and asked me what the problem was i told him becuase his picc was plugged. he said was a line clamped? i said we unclamped it and tried to flush it but there was too much resistance. then er doc told me we should never ever clamp picc line. this is the first time i ever heard of this. since i worked as a nurse, we often clamp either picc line or peripheral line to prevent blood from backflowing after we give medication and flush the line. so does clamping picc line cause line to clog? we clamp it after we flush it with saline.

and second what is your facilitys protocol regarding flushing picc line? if patient is receiving medication like vanco, shouldnt it be flushed with heparin? we use sash protocol by flushing it with saline, med, saline, heparin. how often do you flush the line? thanks for any info.

as previous posters said, if the picc line has a clamp on it, use it and clamp using positive pressure flushing if your catheter is open ended and you don't have a positive displacement injection port on its end.

positive pressure flushing will decrease a reflux of blood into the iv catheter because if you are doing it correctly, you are injecting small bursts of saline and then clamping the catheter as you are pushing in the last 0.2-0.4 mls of the solution. if, however, your iv catheter has a positive displacement injection cap on its end (ie. flolink) , you flush the line using small bursts of fluid, and then leaving approx. 2/10ths of a cc in your syringe, you disconnect your syringe, wait 10 seconds then clamp your catheter or your extension set.

valved iv catheters, like the "solo" or "groshong" have a integral valve which remains closed unless negative or positive pressure is placed on the line with withdraw or infusion.

the md that spoke with you was not correct. and...it is a good thing that you stopped flushing once you met resistance. you do not want to blow a hole in the catheter or send a catheter emboli.

do you not work with a pharmacy that has nurses that can administer cathflo if no one at your facility can? cathflo can be given which will open the majority of picc's when the line is not occluded with a precipitate. of course an order is needed for it, as well as a knowledge on its proper use.

hope this helps..

[Daytonite, BSN, RN]

i think what the er doc meant was the picc line itself should never be clamped. most don't come with them and most aren't manufactured to be clamped. the only things that get clamped are the extension lines that are attached to them.

here is a great informational site about piccs for you:

• http://picclinenursing.com/picc_lines.html

[wonderbee, BSN, RN]

SASH seems to be on its way out. We were taught SASH in nursing school but in practical application, the protocol at my facility is 10cc saline each shift.

There can be several reasons for resistance in a PICC. They are not stitched in and tend to move in the vessel. They can get kinked.

The ER doc would be wise to leave the nursing to the nurses. Unless of course he doesn't mind if you practice medicine. If it's got a clamp on it, there's a reason.