Peripherally Inserted Central Catheter—PICC Giving Medications and Heparin Flush

What is a PICC line?

• A PICC line is a thin, hollow, plastic tube most often placed into a vein in the inner elbow or upper arm. The tip goes into the large vein near the heart. It is a temporary line that will be removed at the end of treatment.
• Some medication and fluids can irritate the small veins of the hands and feet. By using a PICC line in a larger vein, the number of times your child will be stuck with a needle for giving medications and fluids can be reduced.
• A PICC line can also be used to draw blood for laboratory work.
• The tube is flexible, so bending the arm does not cause harm. The line should not limit normal activity.
• Avoid rough activities which may cause the catheter to be damaged or dislodged.
• It is very important to keep the PICC line dressing clean and dry.
  • Your child should still shower/bathe everyday at home.
    • Wrap PICC line with Press and Seal or Aquaguard.
    • Do not submerge PICC line in water.
• The most common risk with PICC lines is infection.
• Other risks can be bleeding or bruising, irritation of the vein, or movement of the catheter tip.
• Please ask your child’s nurse or doctor if you have any questions or concerns.

Giving Medications & Flushing the PICC Line

• If medications are given at home through the PICC line, flush the line after every use with sterile saline and then heparin solution.
• If the PICC line is not being used to administer medications, flush each lumen every day with sterile saline and then heparin solution. Be sure to clamp the line before disconnecting a syringe or tubing. Be sure to unclamp the line before injecting the saline, medication, or heparin solution.

Equipment Needed:

• Alcohol Wipes
• Gloves
• 2 syringes filled with 10 mL sterile normal saline
• Syringe filled with 1 mL heparin solution (10units/mL)
• Medication to be administered
• Syringe disposal box

Necessary Steps:

1. Clear working area.
2. Gather equipment and place on clean surface.
3. Wash hands thoroughly with soap and water for 20 seconds.
4. Inspect PICC line site for signs of infection (redness, warmth, puffiness or drainage) or movement (puffiness, pain, fluid leaking at insertion site). If any of these signs are present, stop procedure and inform the doctor or home health nurse.
5. Prepare one saline syringe. Hold saline syringe upright with syringe tip at the top. Gently tap the sides push plunger to remove air bubbles.
6. Scrub the injection cap with an alcohol wipe for 10 seconds, using a twisting, friction scrub. Then allow to dry for 10 seconds.
7. Twist the saline syringe onto the injection cap.
8. Inject 5-10 mL of saline. Remove syringe from the injection cap. If resistance is met or if signs of movement are seen (puffiness, pain, leakage of fluid at insertion site), stop infusing the saline and call the doctor or home health nurse.
9. Scrub the injection cap with an alcohol wipe for 10 seconds, using a twisting, friction scrub. Then allow to dry for 10 seconds.
10. Insert the medication syringe/tubing into injection cap and secure by turning.
11. Give the medication as instructed.
12. When medication is complete, wash hands thoroughly with soap and water for 20 seconds. Remove syringe/tubing.
13. Prepare saline and heparin syringes. Hold saline syringe upright with syringe tip at the top. Gently tap the sides push plunger to remove air bubbles.
14. Repeat steps 6 to 8 to inject 5-10 mL of normal saline.
15. Scrub the injection cap with an alcohol wipe for 10 seconds, using a twisting, friction scrub. Then allow to dry for 10 seconds.
16. Inject 1mL of heparin solution (10 units/mL) into the injection cap. While pushing the last 0.1mL of heparin, clamp the line at the same time. Remove syringe from injection cap.
17. Place used syringes in syringe disposal box.
18. Remove gloves and wash hands.

PICC line dressing

• The dressing helps keep the line from getting infected and secures the tube so it will not come out.
• Keep the dressing clean and dry. Protect it from moisture. Consider using a covering or sleeve to keep PICC protected.
• If the dressing becomes loose or there is excessive drainage, it should be changed immediately. Call your doctor or home health nurse.
• The dressing is to be changed once a week by the clinic or home health nurse.
• Never use sharp instruments like scissors near the PICC line.

Home Care

• The cap must remain in place and is changed every 7 days by the clinic or home health nurse.
• Be sure your child’s teachers, school nurse and PE teacher are aware of the PICC line.
• While your child has the PICC line, he/she should not participate in PE, roughhousing, sports, or lifting greater than 10 pounds.
• Make sure to carry extra caps, clamps, and dressing supplies.
• Do not use supplies if they fall on the floor.