When to clamp a PICC

[empatheticRN]

we just had an in-service which says that we remove the syringe and then clamp the PICC. All this time I clamped first after I heparinized the PICC , remove the syringe then cap. Which order do you use and what is your rationale? Thanks in advance.

[Double-Helix, BSN, RN]

It depends on what kind of cap you have on the line. If it's a neutral pressure cap, it doesn't really matter. Since I'm not so well versed in the terminology, I'm going to quote a knowledgable poster from a previous thread:

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.

One thing you said concerns me:

All this time I clamped first after I heparinized the PICC , remove the syringe then cap.

Caps should never be routinely removed from central lines due to the increased risk of introducing bacteria into the line. If you are removing the cap for some reason, such as a scheduled cap change, the line must be clamped before the cap is removed or the patient is at risk for air embolism.

[sweetlilwolf]

I'm thinking she means like the green clean cap?