Peripherally Inserted Central Catheter—PICC 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 A Heparin Flush

• The PICC line lumens need to be flushed every day at home.

Equipment Needed

• Alcohol Wipes
• Syringe filled with 1 mL heparin solution (10units/mL)
• CHOC supply box
• Tray

Equipment Needed

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. Always check heparin concentration (10 units/mL) and expiration date on the syringe before using. Daily heparin dose is 10 units/1cc in each lumen.
6. Prepare one saline syringe. Hold saline syringe upright with syringe tip at the top. Gently tap the sides push plunger to remove air bubbles. Avoid touching the tip of the syringe.
7. Scrub the injection cap with an alcohol wipe for 10 seconds, using a twisting, friction scrub. Then allow to dry for 10 seconds. Avoid touching the cap after cleaning.
8. Attach the heparin syringe onto the injection cap by pushing it in and twisting.
9. Unclamp the line.
10. Slowly push the heparin in using a push-pause technique. Re-clamp the line after pushing in the 1ml.
11. Remove the syringe.
12. Repeat for 2nd lumen if present.

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.