I work in the community setting doing homecare visits.
Our clients (patients)can receive their iv med via Cadd pump with a CVAD - usually a PICC line.
We do not give lipids , tpn. We give Vanco,ceftriaxone, cefazolin to name a few.
Here is our policy-
Flush turbulent with 0.9% NaCl - 10 mls before and at least 20 mls after (2 or 3 -10ml syringes) with intermittent use; • With continuous use, flush turbulent with at least 20 mls 0.9% NaCl, after checking blood return, when changing tubing and caps. (72-96 hrs)
Change continuous tubing every 72-96 hrs Change intermittent tubing every 24 hrs (for both primary and secondary IV sets) Intermittent are those infusions where the tubing is disconnected until the next dose and the CVAD is flushed and locked.
We have in the past had frequent issues with our PICC lines not giving blood return or Flushing well.New policy developed /updated to discard the blood filled syringe post blood check and changed to microclave clear neutral caps.On the whole, less issues.
However some staff , on a continous infusion, will still check for blood return and flush daily or twice daily-if we are replacing a bag at 12 hours because they want to "maintain patency and kvo isn't enough pressure to clean the PICC line."
Our policy also indicates checking blood return and flushing prior to each med administration. .and their rationale on a continous infusion . "Adding a med bag to a pump line is administering" ..
Vanco is "stickier and potential for precipitate to form..frequent flushing is required."
Our policy clearly states on continous infusions to check blood return and flush with cap and line changes every 72-96 hrs.
I believe the continous infusion being flushed more freguently -now warrants a intermittent line change frequency .Every 24 hours.
Isn't the very reason we change intermittent tubing because of the frequent disconnect and reconnect? And potentail for infection due to opening the system.
Does it matter how long it has been disconnected. .say 3 mins.to access patency of a PICC.Once you apply the fresh new fluid path system ..it is no longer considered a continous tubing if it is opened ? 3 min or 12 hours. It's has now been opened.
Am I wrong in thinking this?
Please point me in the correct direction if I am wrong in my thought process.
I appreciate any and all comments.
Thank you in advance for your help