I was just wondering what everyone is doing for PICC flushes. We currently flush every 8 hours, turbulent, with saline only and use 10 mls. AVA and INS do not take a stand that I can find. Articles would be great since we are re-writing our VAD policies. Has anyone seen a firm idea except for the INS cards? Thanks ahead of time!
There is no evidence for frequency. Q 8 hours is ok if that is the frequency of the intermittent infusions, otherwise after each infusion is required whether that is q 24, q 12, etc. There is no evidence that turbulent technique is necessary, negative, positive or neutral. There is much confusing evidence when comparing saline to heparin. One systematic literature review recently found the outcomes equal. With the clinical and financial risk of CVC insertion much greater than a short peripheral, I would not consider equivalent outcomes to be sufficient, so would still use heparin for catheter locking. 10 mL syringe is required for catheter flushing but after establishing catheter patency, I would use a syringe size that is appropriate for the drug dose, even if this means a 3 or 5 mL syringe. Lynn
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
I see you mentioned flushing with a different size syringe. I know early in our picc learning we were told to only use 10m syringes event if the volume is much less due to the pressure it exerts on the catheter. Is that not the case now? Now that we have the power piccs that could tolerate so much pressure is it ok to use smaller syringes in the lines because of how they are made?
Thanks in advance, Gina Ward R.N., CPAn
Gina Ward R.N., VA-BC
This is applicable to all CVCs, including PICCs power injectable or not. Assess the patency with a 10 mL syringe, checking for resistance and blood return. Then give any and all small volume meds in the syringe appropriately sized to accurately measure the dose required. Do not transfer meds to a larger syringe as this increases risk of contamination, possible loss of part of the dose, and issues with apporpriate labeling. I have taught this practice for at least 14 years, long before power injectable catheter were available. Catheter damage occurs when excessive force is applied against resistance. This damage can occur even with a 10 mL syringe when there is resistance. So syringe size is not the magic prevention bullet that we would like to think it is. Lynn
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
There is a big difference in the speed and force applied during a med administration vs. catheter flush. Yes, use 10ml syringes for flush always - but for IV med administration a smaller size syringe may be more appropriate for the dose. In most cases, IV meds are given rather slowly over time. A flush, on the other hand, is rapid and exerts more pressure on the cahteter.
Hope this helps!
Nancy Costa CRNI