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Flushing PICC while there is a continuous IV infusion

Hi everybody,

I am designated to write a PICC care policy for my hospital. I am trying to find some supports to back up my point of flushing the PICC with 10mL NS even thought there is a continuous IV line (TPN, PPN, TKO...). I remember I read somewhere that TPN, PPN or Lipid can precipitate and eventually clot the PICC. Dilantin infusion or IVP can also clot up the line. So I thought it would be better to flush the PICC regularly every 12 hours AND after each use, no matter what. So here are my questions. Thanks a lot for any input.

1) Should I routinely flush a continuous IV line?

2) If yes, how can I do it, disconnect the IV line then flush or flush through the IV port that is closest to the PICC?

3) Do you have any literature to support this kind of practice?


Angela Lee
i don't know of any reason

i don't know of any reason to disconnect or enter a line in use for the purpose of flushing only.  I think this would increase infection risk unneccessarily.  I work in pediatrics and we use  low rates especially in our neonates and I have never seen an occlusion due to TPN or lipids.  Dilantin can precipitate in any catheter and I have seen this in PICCs.  Often this can be traced to inadequate flushing after administration when the catheter is used intermittently or the use of glucose solutions to deliver the dilantin.  It is enough of a problem that I either ask for phosphenytoin or do not allow the PICC to be used.  Keep in mind we use smaller catheters than those that are used in adults.

We do not use TKO fluids at all.

I agree with Angela. There

I agree with Angela. There is no valid reason to open or enter a line used for continuous infusion of any kind to flush it on a scheduled basis. There are no studies to support this and I strongly suspect that this additional manipulation will increase your risk of CRBSI. Lines used for continuous infusion should never be disconnected for any reason except to change the administration set at the designated interval. Fat emulsion does have the risk of causing lipid build up along the catheter walls, however this is seen more often when using a TNA or 3-in-1 admixture, and no evidence that flushing will alter this. Read the phenytoin literature closely. This drug is incompatible with all other solutions. So you can have drug precipitate if the line was not adequately flushed immediately before and after each use. I have seen cases where precipitate occured even with adequate flushing. Now that a generic form of fosphenytoin is available for a lower cost, there is no need to  risk loosing any CVC or the risk of extravasation injury from phenytoin by the IV route. If any catheter is experiencing a slowed, sluggish infusion rate or when a pump gives an occlusion alarm, there could be a need to flush the catheter. This would be done on a prn basis when there is a clinical need. It is for the purpose of assessing patency by noting resistance to flushing and checking for a brisk blood return. This flushing should be done through the lowest injection port on the line and disconnection is never required. I would also work toward getting any TKO or KVO fluids discontinued. First, a TKO or KVO order is not a legal order if it does not specify a rate. There are no established rates that will keep open a catheter or vein. And if the patient needs no more than this small amount of IV fluid, they can do without it totally and have the catheter converted to a locked catheter for intermittent infusion of remaining medications. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you so much Angela and
Thank you so much Angela and Lynn. Your inputs are so helpful. I deeply appreciate.
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