A peripherally inserted central catheter (PICC line) is a thin, flexible tube inserted through a vein in the arm, with its tip resting in a large vein near the heart. This placement allows for the safe delivery of medications, nutrients, or fluids over an extended period. A double lumen PICC line contains two separate internal channels within the single catheter body, allowing for the simultaneous administration of incompatible substances or separate access points. Consistent maintenance is necessary to prevent complications and ensure long-term functionality.
Why PICC Line Flushing Is Necessary
Regular flushing is a maintenance practice designed to prevent the catheter from becoming blocked, a condition known as occlusion. When blood or medication residue remains inside the catheter, it can form a clot or a fibrin sheath. Maintaining patency is important so the line can be used reliably for administering medications or drawing blood samples. If the line becomes sluggish or blocked, it may require a specialized procedure or drug to restore function, or even complete removal and replacement.
Flushing helps reduce the risk of infection by clearing any residual drug or nutrient solutions that could otherwise support bacterial growth. By keeping the internal surfaces clean and free of debris, the flushing routine contributes to a lower risk of Central Line-Associated Bloodstream Infections (CLABSIs). This simple step also ensures that different medications do not mix unexpectedly inside the catheter, which is particularly relevant when using a double lumen line where two separate therapies may be running concurrently.
Gathering Necessary Supplies and Ensuring Aseptic Technique
Before beginning, all necessary supplies should be gathered. These materials typically include pre-filled 10-milliliter (mL) syringes of normal saline, antiseptic wipes (often containing alcohol or chlorhexidine), non-sterile gloves, and a sharps container for safe disposal. Only 10 mL or larger syringes are recommended to prevent excessive pressure on the catheter walls.
Strict adherence to aseptic technique is necessary to prevent the introduction of bacteria into the bloodstream. The procedure should always begin with thorough handwashing. Before connecting the syringe, the needleless connector must be vigorously disinfected using the antiseptic wipe, a process known as “scrub the hub.” This scrubbing should last for at least 15 seconds, followed by an air-drying time of at least 15 seconds to ensure the antiseptic agent is fully effective before the line is accessed.
Step-by-Step Procedure for Flushing Double Lumens
Since a double lumen PICC line has two distinct channels, each one must be flushed separately. The first step for the lumen being flushed is to confirm the clamp is closed, which prevents air from entering the bloodstream. After scrubbing the hub and allowing it to dry completely, the saline syringe is attached securely to the needleless connector.
The clamp on the first lumen is then opened, and the saline is injected using the “push-pause” method. This technique involves injecting about 1 milliliter in a quick burst, pausing briefly, and repeating this action until the entire 10 mL volume is delivered. The turbulent flow created by this intermittent injection is more effective than a slow, continuous push at dislodging any residue or small clots adhering to the catheter wall.
As the final milliliter of saline is being injected, the clamp should be closed simultaneously while pressure is still being applied to the syringe plunger. This action creates positive pressure within the catheter, which helps prevent blood from flowing backward into the catheter tip and forming a clot. After the clamp is secured, the syringe is detached, and the hub is scrubbed again before a new sterile cap is placed or the line is prepared for its next use. This entire sequence is then repeated identically for the second lumen.
Troubleshooting Resistance or Pain
During the flushing process, resistance may be encountered when attempting to push the plunger. If this happens, stop immediately and never attempt to force the injection, as excessive pressure can potentially damage the catheter or rupture the line. Resistance usually indicates a mechanical issue, such as a kink in the external tubing or a closed clamp, or a partial occlusion from a blood clot. After checking for external kinks, the patient can be asked to reposition their arm or cough, which can sometimes dislodge the catheter tip from resting against a vein wall.
Pain, swelling, or redness at the insertion site requires immediate attention. These symptoms could indicate phlebitis or a developing infection, both of which are serious complications. If any discomfort or signs of inflammation are noted during the flush, the procedure must be stopped, and a healthcare provider should be contacted right away for assessment.