We are trying to revamp our flushing protocol for our PICC lines. This has been prompted because our rates for no blood return within the first week or two have been 80-100%.  We use Interventional Radiology for PICC line insertions. For the last 1.5 years they have been placing Bard Power Ports on everyone. I personally do not like the power ports for multiple reasons. There is only a small percentage of patients who actually need power injectable piccs. So. we are going to place BS Vaxcil PASV. I have used several brands of PICCS and so far BS has the best product. The flushing protocol for the V. PASV will be NS only with a clave injection cap. But, we are still planning to place some power piccs for certain patients. I have read many studies, resources, and opinions and we cannot decide strength or amount of heparin to use. Any suggestions.
Thanks
Karen
Sorry, I meant Bard power piccs.
Karen
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
What has changed in your environment to bring about the increase in clotted and withdrawal occlusions.? Is there a turn over in staff and a gap in education? I find in our setting it is usually a change in staffing with pooreducational support OR more often...... Staff nurses getsloppy with their care as they get busier and flushes get missed. blood draws through lines are not done correctly etc.... We seem to see a number of times that the staff nurse cannot get blood from a line and we simply change the cap andstart over and it works..... They do not change caps in our organization.....Sad but true. IV team does that and dressings and primary tubings. Just call us the tubing Naxis! It's alright though we do perform other more hihgly skilled procedures as well.
Jose Delp RN BSNClinical coordinator IV Team
Upper Chesapeake Health
Jose Delp RN BSN
CliClinical Nurse Manager IV Team
Upper Chesapeake Health
"...heparin should be used with caution because it poses the risk of serious complications even in small doses. Heparin has been associated with iatrogenic hemorrhage (a lifethreatening reaction to heparin), heparin induced thrombocytopenia (HIT), drug nteractions and inaccurate blood results (Dougherty, 1997; EPIC 2001b; Hadaway, 2001). Therefore, it should be used only when necessary in order to reduce heparin-related complications." (page 30)
Unfortunately, I don't have the reference for Kelli Rosenthall's article on HIT. A few other references:
Hadaway L. Heparin Locking for Central Venous Catheters. Accessed at http://www.hadawayassociates.com/ (in the Clinical Articles tab)
Swanson, J. Heparin-induced thrombocytopenia: A general review. Journal of Infusion Nursing. 2007;30(4):232-?
Kadidal C et al. Heparin-induced thrombocytopenia (HIT) due to thrombocytopenia: a report of 3 cases. Journal of Internal Medicine 1999; 246: 325±
Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: Recognition, treatment, and prevention. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126:311S-337S.
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada