We have been having problems with small PICCs occasionally clotting off in some of our infant population on the pediatric unit. I am trying to come up with a physician order set to hopefully help prevent these PICCs from clotting in the future.
Input please?
You answer does not lie in a physician order. It is related to nursing technique. What type of needleless connector are you using - negative or positive or neutral displacement? ARe they using the correct clamping sequence for the type in use? What type syringe are you using to flush these lines? If it is a traditional syringe filled by pharmacy or the nurses, you can easily get syringe induced reflux. A small amount of blood will reflux for a much greater distance in a small lumen, and clot faster. Also, are you trying to use saline only or still using heparin lock solution? No clinical evidence for saline only with these connectors and what we do have shows higher rates of occlusion and infection. So return to heparin 10 units per mL as per the INS standards if you are using saline only. There are numerous publications about all of this. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In addition to Lynn's comments, if the PICCs are a 1.9/2Fr PICC, a continuous infusion with heparininzed saline may be beneficial. There was an article by Shaw et al., (2007) in Pediatrics, that demonstrated decrease catheter occlusion with a continuous infusion. A typical infusion may be D5W with 1/4u Heparinized saline at 2mL/hr.
If a 1.9/2Fr PICC is locked, 10u/mL of heparinized saline is recommended, 1mL q 6 hrs.
For 3Fr PICCs, they are typically flushed every 8 hrs with 2mL of heparinized saline (10u/mL).
Darcy Doellman RN, BSN, CRNI, VA-BC
Vascular Access Nurse
Cincinnati Children's Hospital