A peripherally inserted central catheter (PICC line) provides extended intravenous access. This thin, flexible tube is inserted into a vein in the upper arm, with its tip near the heart. PICC lines are used for various medical needs, including long-term medication delivery (e.g., antibiotics, chemotherapy), liquid nutrition, and frequent blood draws. Proper care ensures the catheter remains functional and safe.
The Purpose of PICC Line Flushing
Regular flushing is fundamental to PICC line maintenance. Its primary purpose is to prevent blood clots within the catheter’s lumen. Without routine flushing, blood can stagnate and clot, leading to blockages that render the line unusable.
Flushing also maintains the catheter’s patency, ensuring it remains open for unimpeded flow of medications or fluids. This ensures effective treatment delivery. Additionally, flushing clears residual medication or debris from catheter walls, preventing incompatible substance mixing and reducing occlusion risk.
Recommended Flushing Frequencies
The frequency of PICC line flushing, especially when inactive, varies based on specific protocols and catheter types. Generally, if a PICC line is not used for infusions or blood draws, it should be flushed at least once every 24 hours with 10 milliliters (mL) of 0.9% normal saline solution. Some catheter designs, like certain Groshong PICC lines, may only require weekly flushing with 10 mL of saline when inactive. Always follow your healthcare provider’s specific instructions, as protocols differ based on patient condition and the PICC line in place.
Beyond routine maintenance, a PICC line must be flushed immediately after every infusion of medication, fluid, or blood product, and after each blood draw. Normal saline is the most commonly recommended flush solution. In some cases, a small amount of heparinized saline may be prescribed as a “lock” after the saline flush, particularly for certain catheter types or when the line will remain unused for over 8 hours. The use of heparin is often debated and depends on manufacturer guidelines. Always use a 10 mL syringe or larger for flushing to avoid excessive pressure, which could damage the catheter. When flushing, healthcare professionals typically employ a “push-pause” method: injecting the solution in short bursts, followed by a brief pause, and concluding with a positive pressure technique to prevent blood from entering the catheter.
Step-by-Step Flushing Technique
Performing a PICC line flush requires meticulous attention to detail and sterile technique to prevent complications. Begin by thoroughly washing your hands with soap and water for at least 20 seconds, ensuring they are completely clean, and then put on clean medical gloves. Gather all necessary supplies, including pre-filled saline syringe(s) and alcohol or chlorhexidine wipes, and place them on a clean surface.
Next, prepare the injection cap by scrubbing it vigorously with an alcohol or chlorhexidine wipe for at least 15 seconds. Allow the cap to air dry completely for at least 15 seconds, ensuring it does not touch any non-sterile surfaces during this time. Once dry, attach the pre-filled saline syringe to the injection cap, twisting it securely into place.
Slowly inject the saline solution using the push-pause method, pushing a small amount, pausing, and repeating until most of the solution is administered. Do not force the plunger if you encounter resistance, as this could indicate an occlusion or catheter damage. As you inject the final 0.5-1 mL of saline, maintain positive pressure on the syringe plunger while simultaneously clamping the PICC line or disconnecting the syringe. This prevents blood from entering the catheter. Dispose of the used syringe and other materials in appropriate waste containers.
Recognizing and Preventing Complications
Despite diligent care, complications can sometimes arise with PICC lines, and recognizing their signs is important for timely intervention. One common issue is occlusion or blockage, which manifests as difficulty flushing the line, resistance when attempting to inject solution, or an inability to draw blood. Consistent and proper flushing, using the correct technique and syringe size, is the main way to prevent these blockages.
Infection is another concern, often indicated by redness, swelling, pain, or warmth at the insertion site, or the presence of pus or discharge. Systemic signs like fever or chills may also suggest an infection. Strict adherence to sterile technique during flushing and dressing changes, along with meticulous hand hygiene, significantly reduces the risk of infection.
Catheter displacement or migration can occur if the PICC line shifts from its intended position, potentially indicated by a change in the external length of the catheter, or new swelling or hardness along the vein. Proper securement of the line at the insertion site and avoiding strenuous arm movements or heavy lifting can help prevent this. It is important to contact a healthcare professional immediately if any signs of these complications appear, or if there is persistent pain, swelling, leaking, or difficulty flushing the line.