Flushing the PICC Line

The CDC recommends the concentration of flushing solution and the frequency of flushing a PICC line is determined in accordance with manufacturer’s instructions and per the treating clinician’s orders (CDC 2011).

To maintain patency and avoid catheter occlusion, the PICC line should be flushed before and after infusion with any substance (e.g. antibiotics, medications, etc) or when any blood sample is taken. Flushing is usually done with normal saline or heparin flush.

When the PICC line has been used to administer a drug that is incompatible with heparin, e.g. doxorubicin, droperidol, ciprofloxacin, and mitoxantrone,etc. the line should be flushed with 0.9% Sodium Chloride Injection, USP before and after the medication is administered (Drugs.com).

CDC Recommendations (Adults)

General Maintenance and Access Procedures for PICC Catheter

• Maintain aseptic technique
• Perform hand hygiene and assemble the necessary equipment
• Wear clean gloves
• Scrub the injection cap (e.g., needleless connector) with an appropriate antiseptic (e.g., chlorhexidine, povidone iodine, or 70% alcohol), and allow to dry (if povidone iodine is used, it should dry for at least 2 minutes)
• Access the injection cap with the syringe or IV tubing (opening the clamp, if necessary)
• Perform hand hygiene when done

Blood Draws

• Access the catheter as outlined above, maintaining aseptic technique
• Remove the first 3-5 mL of blood and discard
• Obtain specimen
• Flush with 10-20 mL of normal saline (clamping the catheter as flushing is completed, if necessary) and promptly dispose of used syringe(s)
• Perform hand hygiene when done

Flushing technique

Refer to the manufacturer’s instructions of the catheter and the needleless connector for the appropriate technique to use; unless otherwise specified, perform the following:

• Single-use flushing systems (e.g., single-dose vials, prefilled syringes) should be used
• Access the catheter as outlined above, maintaining aseptic technique
• In general, avoid using a syringe less than 3 mL in size to flush, preferably use 10 mL
• Flush the catheter vigorously using pulsating technique and maintain pressure at the end of the flush to prevent reflux
• Positive pressure technique (may not apply to neutral-displacement or positive-displacement needleless connectors):
  • Flush the catheter, continue to hold the plunger of the syringe while closing the clamp on the catheter and then disconnect the syringe
  • For catheters without a clamp, withdraw the syringe as the last 0.5-1 mL of fluid is flushed
• Promptly dispose of used syringe(s)
• Perform hand hygiene when done

Changing the Injection Cap (e.g., Needleless Connector)

Refer to manufacturer’s instructions for how frequently to change the injection cap; if information is not available, in general, change every week or when there are signs of blood, precipitate, cracks, leaks, or other defects, or when the septum is no longer intact.

• Maintain aseptic technique
• Perform hand hygiene and assemble the necessary equipment
• Wear clean gloves
• Scrub the injection cap and catheter hub with appropriate antiseptic agent; clamp the catheter if necessary as cap is removed
• Attach new cap to catheter hub using aseptic technique
• Perform hand hygiene when done

References:

CDC Basic Infection Control And Prevention Plan for Outpatient Oncology Settings (2011) Retrieved from https://www.cdc.gov/hai/pdfs/guidelines/basic-infection-control-prevention-plan-2011.pdf

Heparin Flush Dosage. Drugs.com. Retrieved from https://www.drugs.com/dosage/heparin-flush.html

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