    This maybe a silly question, but I have to ask. Is it possible to have an air embolism in Power PICC during insertion?? For example: If you have primed the PICC with saline and you do not put the caps on, and leave the clamps open ,can the end result be an air emblosim?? I have a bad habit of waiting to put my caps on after the picc is advanced, then I put caps on and apply the dressing. Thanks in advance for you input.
Any time you have a central venous catheter of any kind with the tip inside the thorax and that line is opened for any reason, you are at risk for producing an air emboli. If the patient is sitting or standing or takes a deep breath or is dehydrated and that line is open, the risk greatly increases. So you need to leave the wire in place until you have the PICC properly positioned, then remove the wire and either fold the catheter, close a clamp or put your sterile gloved thumb over the hub, reach for the needleless connector and then quickly move your thumb. The only catheter where there is less risk of air emboli is when placing a catheter with an integral valve. So air emboli precautions are required when you are inserting a PICC or any CVC, changing tubing/caps, and removing.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Definitely cap each lumen. See if the company who makes your PICCs provides sterile end caps in the kit (they are not needleless connectors). If they don't, ask them to provide them in the kit. I prefer the sterile caps to the connector until I'm completely finished but still in sterile garb - then add primed connectors (keeping my thumb over when removing the catheter stylet ((wire)) swiftly).
I also like to add an end cap to the end of the dilator portion of the microintroducer.
1st: get the microintroducer guidewire out asap and put your sterile finger over the dilator hole, either returning the wire to the plastic sheath and then placing on sterile procedure TABLE, or just move it right to the sterile procedure TABLE. I prefer containing it in the sheath and remove from the procedure AREA (near the arm), being mindful not to poke my glove or finger with it.
2nd: remove your finger from the dilator and quickly put a sterile cap on the end.
3rd: back the dilator out of the microintroducer just a titch so that the point of the dilator is not resting/poking on the tunica intima.
Now you have time to cut your catheter to the correct length, without risking guidewire migration/embolus or air embolus.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center