PICC - Dos and Don'ts

“VENIFACTS” NEWSLETTER

                                                                                  January 16, 2002

 PICCS – DOs and DON’Ts

PICCs are special. They are not big and strong like a central line. They are often held in by tape instead of sutures. They are not as easy to push through as a big central line. Here are some DOs and DON’ts about PICC line catheters.

1.                  Always assume that the line is not sutured in place when removing a dressing. Pull the dressing upward and inward toward the insertion site. NEVER downward. Pulling down on the dressing could pull the PICC out.

2.                  Secure the hub of the catheter by using Benzoin and steristrips keeping the steristrips off of the catheter.

3.                  Apply the transparent dressing without gauze underneath unless the site is weeping. If the site is weeping, daily gauze dressings are necessary for proper site observation.

4.                  Keep the tape secure over the insertion site. Weight of the tubing has been known to pull the catheter out from under loose dressings.

5.                  Flush with non-preservative normal saline and heparin flush whenever disconnecting IV fluids. The act of pulling the tubing out of the port pulls blood into the catheter. Even if your IV fluid was NSS, you still must flush with NSS and Heparin using positive pressure.

If the catheter migrates out, it is important to measure the length of the catheter external and compare it to the measurement on the wall sign. Inform the PICC nurse. If she is unavailable, get a Xray to make sure tip placement is still in the appropriate place for the IV solutions being administered. You must have superior vena cava placement for TPN.

 DON’Ts FOR PICC LINES MAINTENANCE.

1.                  NEVER forcefully inject through a PICC line. These catheters are more delicate than other central line catheters. Pushing too hard can easily rupture the catheter potentially causing air emboli.

2.                  NEVER allow the hub of the catheter to be unsecured. If the hub of the catheter moves freely the catheter will migrate out. Heavy tubing can pull the catheter out if the hub is not well secured.

3.                  Never use a PICC line that does not have a blood return. If the tip is appropriately placed, a blood return will be easily obtained.

4.                  Be gentle when drawing blood from PICC. If you aspirate too hard you can actually collapse the catheter and you will not get a blood return.

5.                  NEVER disconnect IV fluid or IV NSS following a piggyback without flushing the line with saline followed by heparin flush. You must flush the line with a syringe full of saline followed by heparin whenever you stop or discontinue IV fluids infusing through a PICC. This line is small and will clot easily and quickly.

6.                  Never leave a PICC line without a clamp. If the manufacturer does not place a clamp on the catheter, add a small IV extension tubing to the hub of the PICC. The extension tubings have a clamp on them.

7.                  NEVER try to declot a PICC without removing the extension. Declot directly at the hub of the catheter.