Hi,
I am a solo PICC RN having a round robin debate with a long term care facility that is not associated with the acute care facility where I am employed. I need assistance, if possible. I place PICC lines and then attach a m..plus positive displacement valve at the time of insertion. The long term care facility states that this is not a valved PICC line. Hmmmm..... Seems so simple, but round and round we go. The long term care facility (which is a large corporation encompassing all local nursing homes) says the picc is only valved if it has an integral valve. Like the (vaxcell, or bard) where the valve does not come on and off but the PICC is one piece with the nonremovable valve. So, anyway they would like our printed info to say this is not a valved PICC, but the documentation we use states (yes) to a checkbox positive displacement valve.
My question Would there be any difference in PICC care and mantenance of a PICC with a valve attached, or a PICC one piece with a valve on it?
I am not associated with any vendors.
Thanks
All central lines, valved or non-valved need a needleless connector on them unless they are infusing continuous. I am not sure what their thought is regarding the different PICC brands/types. We place the Navalyst Xcela PASV and still put needleless connectors on them. Sounds like they need some education??? Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
There is a difference. A valved catheter is one with some type of vallve built into the catheter itself, either on the internal end or the external hub. A needleless connector is an add-on device. There concern may be based on the marketing information from the valved PICC manufacturers. They all state instructions to use saline only for flushing and locking these catheters. Some may also believe that the presence of a non-removable valve will prevent the risk of air emboli if the connection comes apart.
Evidence from the published literature on these claims are conflicting and confusing. See INS standard on flushing and locking. This leads me to believe there could be a performance difference between the location and design of these valves but I do not know of any study that has performed a direct comparision.
Some needleless connectors also claim saline only but there is no published literature to support that instructions with positive patient outcomes.
So the LTC staff is correct about valved catheters, but they may or may not be providing the benefits they are expecting from them. I would begin by having a discussion about why they want only valved catheters. Then provide the evidence to them and make a good clinical decision based on this evidence.
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
Our pharmacy only places Valved Midlines and Valved PICC's. We use Bard's Groshong IV catheters. These IV catheters have an integral valve at their distal end, and flushing is only done using NSS. We can avoid HIT in our patients as long as our catheters don't require the use of Heparin Flush. We also use them exclusively as they are easily repaired and in LTC, that is a WONDERFUL thing.
Now our caps our of the positive displacement design (Max Clear). But if this device were on a non-valved IV catheter, to me, that doesn't make the IV catheter valved.
I know that many manufacturers of these needleless connectors claim that NS is only needed if this cap is intact, but that is because of the displacement aspect of this cap after the syringe is removed.