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Corey Mertz
Checking Blood Return on PICC lines/Central Lines

Should blood return be checked prior to using PICC line & or Central Line every time? I've heard this comes from INS, but had difficulty locating this in the standards of care.

I guess the risk is a large fibrin sheath(sock) may form over the entire catheter and the medication/vessicant can track back to the site and the subcutaneous tissue. I have a hard time believing this can happen to a PICC line and find the potential for increasing risks of clogging/infection and flushing non-compliance by doing this more than once every 24hrs. 

What are the policies/practices of other facilities? Is it standard practice verifying blood return from central lines prior to every medication infusion/fluid start and to initiate thrombolitic protocol when blood return isn't possible? Also, are you routinely getting CXR's to re-verify tip placement when unable to get blood return?

We flush and check for blood

We flush and check for blood return on  all PICCs and central lines twice a day (when in use) and before each use. If no blood return is found-we contact the MD for tPA orders

INS standard 50 - Flushing - under Practice Criteria M and N

We only CXR if we are worried about catheter migration

Interventional ...
Blood return check on PICC's & CVC's

Our flush policy is Q12 and after each use with 20 cc NS / port using push / pause technique for PICC's.  We do look for blood return as well. For CVC's ,policy is for blood return prior to use, no return, CXR to verify placement. If proper tip position contact physician.  All thrombolitics are administered by physicians at our facilities.

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