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Power PICCs plugging

We are just starting to trial the Power PICCs, using the Ultrasite positive displacement caps that come in the BARD kits. 

At the same time, the MICU and SICU units are trialing positive displacement caps (Flolink) (our hospital has been behind the times and still using the original ICU Med negative displacement caps). 

We're having trouble with plugged Power PICCS now - with both the Ultrasite and Flolink caps.  Despite education and reinforcement about changing flushing technique to allow positive displacement to occur, I'm assuming the PICCs are plugging because not every nurse is doing this yet.

Lynn - you also mentioned syringe issues - can you elaborate?  We're using Kendall monoject luer locks and also the Kendall prefilled.

Anyone else have other suggestions? 

Good success rate with Power PICCs and saline flushes?

 At least 95% of the PICCs

 At least 95% of the PICCs we insert here are Power PICCs.  For many years we used the Ultrasite valve, but about four months ago switched to the MicroCLAVE.  The Ultrasite is a positive displacement valve, and the MicroCLAVE is a neutral displacement valve.  I have not seen any increase in occluded lines since switiching to the neutral displacement valve. 

Occluded lines account for only about 25% of the occlusions which require TPA here.  The rest are persistant withdrawal occlusions which prevent us from obtaining blood for labs.

Of the lines that are occluded, the vast majority are the result of nurses failing to disconnect the pump tubing from the line when an infusion is completed.  They simply turn off the pump to silence the alarm, and leave the tubing connected untill they get around to disconnecting it.  The inactive pump does not function as a clamp and it allows backflow of blood into the line.  A gravity drip which has run dry will do the same thing. 

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

All of these comments are
All of these comments are right on the money. Flushing must be regarded as a system which includes the catheter, needleless connector, syringe size and design, and the infusion sets left attached, etc. Changing one piece may not alter your outcomes. 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

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