The Smart Site Plus will work well. As you know, it is a positive pressure needleless injection cap, which is exactly the type of needleless injection cap Bard recommends for use with all it's PICC products, including the PowerPICC SOLO*. Bard does not make specific recommendations for one positive pressure needleless injection cap over another. In speaking with clinicians currently using the PowerPICC SOLO*, I've been told they are using a multitude of positive pressure needleless injection caps, including the Smart Site Plus, MaxPlus, and Ultrasite, to name a few. As with any PICC, the needleless injection cap is only one factor that contributes to the success of the catheter. Adherence to good flushing technique is just as important.
Use of a 10ml syringe with the PowerPICC SOLO* is recommended in an effort to decrease confusion. Syringes can generate pressures that are greater than the PICC can tolerate. This potential is greater, the smaller the syringe is. Most PICC manufacturers recommend the use of a syringe that is no smaller than 10mls, even though some PICCs may tolerate higher pressures. To that end, it is much easier for clinicians, especially those that don't deal with PICCs daily, to remember that the smallest syinge they should use is 10mls.
OK, now I am confused...I was under the impression that by having a valved catheter we would be able to get away from positive pressure end caps. If you are saying that a positive pressure end cap like the smart site, CLC 2000, etc. is recommended for the SOLO, then what is the purpose of the SOLO or PASV PICC??
I have been using the CLC 2000 for years with saline only. Why are we being charged much more for a valved catheter that still recommends the use of a positive pressure end cap?
PASV catheters were designed to be capped with a new sterile solid end cap after each use. There have been several issues with that process though. These caps are not available in the facility or the facility did not wish to have 2 capping systems - this solid cap for the PASV catheters and another needleless connector for all others. So to simplify most facilities will want to place the same connector on all catheters. I am assuming that the same issues will apply to Solo.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Bard Access Systems
Eric you do not have to use a positive pressure cap with Solo. You must as with any catheter you choose do positive pressure flushing when disengaging
Below is some Saline Flushing information that I found on the ICU Medical (CLC 2000 and MicroClave caps). My facility already uses the CLC 2000 so why would I need to spend the extra money on the valved SOLO PICC when I already have a Saline Only PICC with either of these valves?
Since you keep bringing up the same question on the Solo PICC. I will post my reply again. It sounds like you are happy with what you are using. If what you are doing works at your facility, then don't worry about the Solo. My earlier post is below.
We are currently heprin free at our hospital. You can not relay on a nurse on the floor to always put a positive pressure cap on that PICC. The other problem we have is the clamping sequence. If the nurse clamps at the wrong time it totally negates the purpose of that positive pressure cap. This happens all the time. In addition, many of our home health agencies do not even keep positive pressure caps. As you can imagine, this is an issue. I see the benefit in a valved PICC even if it does cost a little more. If it will help reduce the confusion, then it is worth it to take a look at this product. By the way, when has new technology ever been cheaper.
Ok we have the clave11956 connector which it is having back flow issues, even with proper teaching. What can we tell the nurses on the floor for the correct flushing method,sequence? Please enlighten me.
Here is the link to the Positive Flush Technique PDF. You can download it or you can ask your ICU Rep to get you some.
You can also use the MicroClave 12568 which is neutral displacement and has saline flush only claim.
Why do we use a positive luer activated device with the SOLO? A valved catheter need normal saline, an open ended catheter needs heparin. That is the purpose from the valve. The LAD in relation to the catheter prevents occlusion if you use the right one. These are 2 different things, but they work together.
I am sure you talk to me DrDNA. Yes, Bard recommend neutral or positive luer activated devices. I did not say anything else.
But if you prefer to talk about malpractice...... Bard recommend that the tip is in the SVC, so, how often do we end up midsubclavian because we are not able to get down.
I assume you are a physician, how often is a dialysis catheter placed in the right atrium because the inserting physician prefers this location....
However, the Bard SOLO catheter should not be used with a negative LAD.
To clear on the confusion as to why we need to go with the pasv(pressure activated safety valve) piccs is to reduce the number of occluded catheters. Traditional catheters have a clamping mechanism which we should always flush and clamp as we're flushing to lock the solution (heparin/saline). The problem is that some nurse flush and don't clamp or don't clamp while they are flushing the cath; therefore some blood enters into catheter and then you have an occluded catheter.
Anything picc or other form of central line that has a clamping device system in their tubing must be lock to keep the tube free from blood entering the catheter and forming a clot/occluded cath.
So regardless of what type of cap Neg. or Positive and if there is a clamp you must still clamp. With the positve caps you flush, then you clamp. The PASV piccs act like that clamp except is an internal mechanism that keeps for the (most) part the saline locked in the catheter. That is why it is extremely important to use positive only caps on this devices because negative caps will alter the effect of valve to a certain point and will draw small amount of blood into the lumen of the catheter then it's Cathflow time or new PICC time.
I highly recommend the Maxplus clear caps. I rememember doing rounds on our piccs with the rep of Maxplus and while we were chaning our caps for trial purposes 4 out 10 piccs had at least one port occluded, we were using negative caps (clear link) and as soon as we went to the Max plus clear. Zero>>>
I hope this helps.
PICC VIC RN
It has always been my understanding that when you use positive fluid displacement caps that no clamping is required and the only time there is a need to clamp is during cap changes. I was taught that clamping the catheter defeats the mechanism of the cap and thus positive fluid displacement is altered and occlusions can occur.
If you have reference to back up this practice please let me know where I can find it.
Lynn, if you are reading this please let us know your thoughts.
Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
I strongly believe that catheter clamping is a critical component of patient safety. Vascular air emboli happens far too easily and one of the frequent times is when the tubing or needleless connector becomes loosened from the catheter hub. A clamped catheter will protect against air getting into the line. Remember air emboli can cause devasting effects on your patient and the treatment, which could be a nursing home for the remainder of their life, is not reimbursed to the hospital. Needleless connectors can be clamped, but it depends upon the function of that NC as to when it is clamped. Negative displacement NC should be clamped before syringe disconnection. Positive displacement NC should be clamped after syringe disconnection and the internal mechanism has had time to work. Neutral displacement NC can be clamped either before or after syringe disconnection. I know this is confusing, but it all depends upon the functionality of the NC and nurses must know which one they are using. Cutting clamps off of a catheter should never be done and I have heard of some NC sales reps recommending this practice. Lynn
I agree with Lynn, never remove clamps...and yes a nurse need to know what type of cap their are using so they can know when to clamp.. with a negative cap as Lynn mention clamp while flushing and before disconnecting...I would also recommend this with the Neutral just to be on the safe site knowing that you locked your saline all the way to the tip of the catheter... with a Positive cap yes flush, disconnect syringe and then clamp..and true if you clamp prior to disconnecting the it will not displace the .25cc of fluid in cap but you're doing it already while flushing..so you'd be ok if you forget..you will still displace that fluid when you undo the clamp..In summary best thing to do is get educated on all the products your facility is using..and always think safety..
Victor Valdez RN
Our experience with the Alaris Smart Site caps was a significant increase in central line infection rate. I don't know what change was made in the Smart Site Plus cap. Hopefully it is improvement. We are using the Bard open ended PICC with a clamp, add on groshong valve called TKO and a BD Q-Syte cap. Our infection rate has dropped. I feel that the complex mechanisms in the positive pressure caps are a factor in infection rates for all central lines. I prefer positive pressure flushing technique and clamp.