A peripherally inserted central catheter, or PICC line, is a long, thin tube inserted into a vein in the upper arm, with the tip resting in a large central vein near the heart. This device provides safe, long-term access for administering medications, fluids, chemotherapy, or nutrition, avoiding repeated needle sticks in smaller veins. Proper flushing is a routine, home-based procedure performed by the patient or a caregiver to maintain the catheter’s function and prevent complications. The primary goal of flushing is to keep the line open (maintaining patency) by clearing residual medications and preventing the formation of blood clots inside the tube.
Essential Preparation Before Starting
Before beginning the flushing process, gather all materials to ensure a sterile and smooth procedure. You will require pre-filled saline syringes, alcohol or chlorhexidine antiseptic wipes, and a dedicated sharps container for disposal. Check the expiration date on all supplies, especially the saline syringes, and confirm the correct volume of flush, typically 10 milliliters (mL) for adults, as prescribed by your healthcare provider.
A clean environment significantly reduces the risk of infection. Select a clean, flat surface and cover it with a fresh paper towel to organize your supplies. Begin by washing your hands thoroughly with soap and running water for at least 20 seconds, scrubbing between the fingers and under the nails. If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol, allowing your hands to air dry completely before touching any equipment.
Detailed Flushing Procedure Steps
The first step in accessing the line involves disinfecting the needleless connector cap. You must “scrub the hub” vigorously with an alcohol or chlorhexidine wipe for a minimum of 15 seconds, using friction and a twisting motion to ensure all surfaces are cleaned. Allow the hub to air dry for at least 15 seconds, as this period is necessary for the antiseptic to effectively kill microorganisms.
Next, prepare the saline syringe by removing its protective cap and gently pushing the plunger to expel any air bubbles and prime the tip with a small drop of saline. Attach the syringe to the clean hub by pushing it on and twisting it clockwise until it is securely locked in place. If your PICC line has an external clamp, unclamp the line before attempting to inject any fluid.
The key to effective flushing is the “push-pause” technique, which creates turbulent flow inside the catheter lumen to dislodge debris and fibrin build-up. Instead of pushing the plunger in one continuous motion, inject the saline in short, rapid bursts, pushing a small amount, pausing briefly, and then pushing again. This stop-start action generates the necessary turbulence to clean the inner walls of the catheter more thoroughly than a steady flow.
Inject the entire prescribed volume of saline, typically 10 mL for most adult PICC lines, using the turbulent push-pause method. Maintaining positive pressure is the final step to prevent blood from flowing back into the catheter tip, which can lead to clotting. As you inject the final 0.5 to 1.0 mL of saline, simultaneously close the external clamp, or if your line has a valved connector, withdraw the syringe while continuing to press slightly on the plunger.
This technique, which involves clamping while injecting the last portion of the flush or immediately after removing the syringe from a valved connector, maintains the positive internal pressure. Finally, unscrew the empty syringe by turning it counter-clockwise, discard it into a designated sharps container, and apply a new disinfecting cap to the hub. If a heparin solution is required after the saline, repeat the scrub-and-flush procedure with the heparin syringe before applying the final cap.
Troubleshooting Common Complications
Resistance, where the plunger is difficult or impossible to push, may indicate a catheter occlusion or a mechanical problem. If you feel any resistance, stop immediately and do not force the flush, as excessive pressure can rupture the catheter or push a clot into the bloodstream. First, check the line for any visible kinks or twists along the external tubing or under the dressing and straighten them out, then ensure all clamps are completely open.
If resistance persists, try repositioning your arm, changing your body position, or gently coughing, as these actions can sometimes shift the catheter tip away from the vein wall. Inability to flush or draw blood may signal a fibrin sheath or a clot at the catheter tip, which requires professional intervention. Contact your healthcare provider or home health nurse if you cannot resolve the resistance after these simple measures.
Pain, burning, or swelling along the arm or at the insertion site during flushing can be a sign of phlebitis or a blood clot. Redness, increased warmth, pus, or localized tenderness around the PICC line insertion site are signs of a potential infection. Any of these symptoms, especially if accompanied by a fever or chills, require prompt reporting to your healthcare team for evaluation and treatment.