What is the recommended procedure for flushing PICCs--every day with normal saline followed by heparin?
Peripherally inserted central catheters (PICCs) are considered "central" devices, that is, the catheter's tip resides in the vena cava. That means a PICC should be maintained as a central vascular access device (CVAD).
If the CVAD isn't in use, using positive pressure flushing technique and flushing a minimum of 1-2 times/day should be sufficient. INS has long recommended using 0.9% sodium chloride solution for injection as the appropriate solution for patency and compatibility flushing.
If the patient's condition permits, heparin in low concentrations is also helpful in "locking" or closing off the catheter after completing the medication infusion. INS recommends that CVADs be routinely flushed and maintained with 100 units/ml heparin, 2-3 ml volumes, depending on the fill-volume of the catheter and the patient's condition: flushing with heparin should not impact the patient's coagulation factors. Heparin also prevents clot formation within the catheter's lumen: clots (or thromboses) provide an excellent medium, or "nidus," in which bacteria can grow. Remember, a PICC has, on average, 50 to 65 cm of length in which a clot can develop.
Remember SASH for the flushing sequence:
S - saline flush
A - administer medication
S - saline flush
H - heparin flush.
Substantial documentation supports flushing vascular access devices, especially PICCs, with heparinized solutions. A specific supporting reference is: Randolph, A.G., Cook, D.J., et al. "Benefit of Heparin in Central Venous and Pulmonary Artery Catheters." Chest, 113:1, January, 1998, p 165-171. I would also direct your attention to several INS Standards of Practice found at www.ins1.org, specifically Standard 67, Flushing, which will be most helpful in your clinical practice.
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