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Flushing CAVD/Piccs

  At our hospital our Picc team teaches a turbulent/push-pause method of flushing each line [CVAD/PICC] with 10cc of normal saline.

In a recent article I've read that this method is NOT recommended. We are confused about this,and would appreciate some

feedback as to how other Vascular Access teams flush their CVAD/PICC lines.

Maureen RN/CRNI

Chris Cavanaugh
Evidence supports this

There was a study done on pigs by Navalyst presented as a poster at INS.  They showed what happens to the catheter when power injecting and flushing.  They showed much more movement of the catherter with a straight push flush vs push pause push pause.  To me, this shows that this practice is beneficial to the patient from a catheter movement perspective.

Another group at INS, a start up company with a syringe that AUTOMATICALLY did the push pause while you pushed, showed SIGNIFICANTLY more proteins removed by this method. 

I always teach it in my classes.

Chris Cavanaugh

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Different interpretation

I don't think the Navilyst poster stated it the same way you did and do not think their work supports the turbulent flushing technique. I was in one of those animal labs and did not find that this technique was beneficial. In fact, just the opposite - forceful, rapid, aggressive flushing technique leads to a greater risk of catheter movement and possible laceration of the vein wall. I watched small silicone PICCs move from the SVC to the subclavian with this technique.

There are numerous statements in the literature on biofilm that the high shear forces leads to biofilm with a greater tensile strength. So this technique could be causing more biofilm. Also, this flushing technique could be causing biofilm to break off and that leads to a BSI.

There is no evidence in my opinion to support it, never has been. So until there is some evidence, either clinical or lab, that shows this decreases the risk of complications. I will not support or teach its use. Our practice must be based on sound evidence. The only thing published on this to date has been opinion pieces, no evidence at all. Lynn

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

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