I am looking for suggestions or flushing protocols for outpatient PICCs where they are not using the PICCs regularly at home and coming into treatment rooms for ?infusions.
My outpatient oncology unit is questioning the flushing of power PICCs and have questions about the regularity of flushes with the open-ended power PICCs.Â
I have been wanting to suggest that a weekly saline flush would probably be sufficient if using positive displacement caps. Ideally, a daily flush would be good but I detect a negativity that I am not using valved catheters and therefore causing problems. I need to decide if I can say that weekly flush is OK or to go with the practise to teach the clients to flush daily with saline. I do realize that I could go to the valved power PICCs but am not going there yet and need to decide what to do now. (I have a call to return from guess who)
There are numerous catheters still being used that do not have any type of integral valve. This includes PICCs, tunneled, and implanted ports. The power-injectable PICCs have a large lumen. The large diameter means that blood will reflux for a short distance. Reflux in a smaller lumen means the blood moves for a longer distance. Of course, if the entire lumen is filled with blood that has clotted, nothing can flow through regardless of whether one or 10 mm of catheter length are involved.
The manufacturers of the needleless connectors make recommendations for the type of fluid to use for flushing and locking, however none of them will make any statements about the frequency of flushing. So flushing once per week with a positive displacement device is not supported by the manufacturers instructions for use. The following is a study of flushing practices for tunneled catheters. The internal lumen diamater for the power injectable PICCs could approach the ID of tunneled catheters. So you could apply the recommendations made in this study.
1. Buswell L, Beyea S. Flushing protocols for tunneled central venous catheters: An integrative review of the literature. The Online Journal of Knowledge Synthesis for Nursing. 1998;5(3).
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
Sesymons--What is a "valved power PICC"?--Weekly saline flush is inadequate for any Open Ended PICC (Power or Plain) regardless of the type of end cap (Positive Negative or Nuetral)--If a catheter is dormant then (at minimum) once a day flushing with 10ml NS is required
Robbin George RN VA-BC
To answer the question about valved power PICCs, Bard now has the 5Fr Power Groshong PICC, a single lumen silicone PICC with the distal Groshong valve that allows a maximum injection rate of 4mL/sec, as accessed at http://bardaccess.com/nurse-powergroshong.php. Apparently will soon be available in Canada as well.
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada