Understanding the Peripherally Inserted Central Catheter (PICC)
A peripherally inserted central catheter, commonly known as a PICC line, is a thin, flexible tube placed into a vein in the upper arm. This catheter is advanced through the vein until its tip rests in a large central vein near the heart. Healthcare professionals use PICC lines to provide long-term intravenous access for various medical needs, including administering medications, fluids, nutrition, or drawing blood samples. Proper care and maintenance are necessary to ensure its safe and effective function.
The Role of Flushing in PICC Line Care
Flushing a PICC line involves pushing a solution through the catheter to keep it clear and functional. This helps prevent blockages, such as blood clots or medication precipitates, that can obstruct the catheter’s internal pathway. Regular flushing maintains the line’s patency, or openness, allowing for consistent and accurate delivery of prescribed therapies.
Normal saline, a sterile solution of water and a small amount of salt, is the most common solution used for flushing PICC lines. In some instances, a heparinized saline solution may be used after the normal saline flush. Heparin, an anticoagulant, helps prevent blood from clotting inside the catheter lumen, especially for lines that will not be accessed for extended periods. The specific flushing solution and volume are always determined by the patient’s healthcare provider based on the individual’s needs and the catheter type.
Determining Flushing Frequency
PICC line flushing frequency varies, with specific instructions provided by the healthcare provider. These instructions are tailored to the individual’s treatment plan, PICC line type, and usage. A minimum 10-milliliter syringe is recommended for flushing to avoid excessive pressure that could damage the catheter.
When flushing, use a turbulent or “push-pause” technique. This involves injecting the solution in short bursts, followed by brief pauses, to create a scrubbing action against the catheter’s inner walls.
For intermittently used PICC lines (not in continuous use), flushing typically occurs once daily or every 12 to 24 hours. Some guidelines suggest flushing every 12 hours for non-active lines. If the line has multiple lumens, each requires individual flushing to maintain patency.
After flushing, a positive pressure technique is often employed, where the plunger is depressed while disconnecting the syringe, to prevent blood from flowing back into the catheter and potentially causing a clot.
Regardless of intermittent use, flush the PICC line immediately before and after each access, including medication administration, fluid infusion, or blood draw. This ensures any residual medication or blood is cleared, preventing build-up that could lead to blockages.
For patients receiving continuous infusions, additional flushing may be incorporated, or the continuous flow of fluids may help maintain patency, though specific protocols should be followed.
Identifying and Addressing Potential Issues
Even with diligent flushing, complications can arise with a PICC line. One common issue is an occlusion or blockage, indicated by an inability to infuse fluids, resistance when flushing, or swelling around the catheter site. If resistance is felt during flushing, stop immediately and never force the flush. Forcing it could damage the catheter or vein, or dislodge a clot.
Infection is another potential complication, with signs including redness, pain, warmth, swelling, or pus at the insertion site. A fever may also indicate a PICC-related infection.
Catheter migration or dislodgement can also occur, noticeable if the external length of the catheter changes, or if there is discomfort in the arm, shoulder, jaw, or chest during infusions.
Contact a healthcare provider immediately if any of these signs or symptoms appear. Patients and caregivers should never attempt to resolve these issues independently. Prompt communication with the medical team allows for timely assessment and intervention, ensuring the continued safety and effectiveness of the PICC line.