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flushing PICC in the middle of a blood transfusion

Do you flush the PICC line half way into a blood transfusion? I have no data to support but I believe it should be flushed. Hopefully I can do a little study at the hospital to find out. A typical PRBC is transfused over 2-4 hours. Even though blood is pumped (or dripped) in thru the PICC continuously but with that extended period of time there must be clotting happening inside the PICC. A good NS flush half way into the transfusion will help keep the PICC wide open. What does everybody think?

I think you need a PICC with

I think you need a PICC with a larger lumen to transfuse blood. PICCs are not well-suited for blood transfusion because of their length. Length adds resistance and that is why you are getting a slow flow rate. You can easily transfuse a unit of PRBCs must faster thru a 20g short peripheral catheter than through the same size PICC. In this situation, I would prefer to use the saline from the bag used to prime the blood set to move saline from the saline bag to the blood bag to dilute the blood. This will decrease the viscosity of the PRBCs and avoid the risk of introducing contamination by flushing the lumen. Of course you must consider the fluid balance and their ability to tolerate this additional fluid. 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

Peter Marino
Transfusing through small gauges.

Our institution’s policy is to place PRBCs transfusions on a pump. We mainly place single lumen 4fr Xcela (Navilyst) PICCs (these are valved) and have no problems with clotting. We also have to transfuse through 24ga. 3/4" PIV's (BD insyte angiocatheters) now and then. We have had no clotting problems with 24ga PIVs either.

 I don’t think the results would be the same via gravity though. I have seen 22ga PIV's clot via gravity.

Another thing to think about is the height of the bag......

Gravity Drip Flow Manual IV System

The pressure available from a bag of saline = the height the bag is above the patient's heart.
If a saline bag is 68cm(27") above the patients heart the infusion pressure available is 50mmHg(1psi).
If the bag is twice that height above the patient 136cm (54") the available pressure is 100mmHg(2psi)

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Kathleen M. Wilson
We haven't had that problem.

We haven't had that problem. We use a pump. What rate are you running it? It doesn't seem right to interrupt a transfusion, break the system, to flush. That indicates to me you need a solution. Could you put in a 20 g just for the transfusion?  Or do a internal study on what size piccs is this happening to, what other meds is the pt. getting, etc. to narrow it down, if possible.


Kathleen Wilson, CRNI

Gwen Irwin
Flushing PICC in middle of transfusion

I have not seen the practice of flushing in the middle of a transfusion.  We use pumps for blood transfusions.  

I agree that gravity transfusions are more problematic.  Gravity transfusion via a peripheral IV slows down and requires rate adjustment via tubing roller clamp.  I am sure that gravity transfusion via PICC would have the same problem.  We have not done gravity transfusion via PICC in over 5 years.  We use pumps for that constant rate and do not flush with saline, either by syringe or by flush bag.

Hope this helps.

Gwen Irwin

Austin, Texas

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