Most facilities now use the Positive Pressure Valve that makes clamping the line unnecessary on PICCs until a cap change is due. The valve automatically reverses the blood reflux associated with conventional valves so there is much less chance of a clot forming at the interior end of the line.
While the chances of getting blood out the line is pretty small, I always wear non-sterile gloves when changing caps, as part of standard precautions, just in case.
Clean for 15 seconds. I teach my patients is to sing one verse of “Happy Birthday” if they don’t have a watch with a second hand. Let the end air dry.
If you put the cap on before dry sometimes it makes the cap and line stick together making it very difficult to unscrew the next week.
If you do come across a cap stuck to the line, it’s very handy to have two Kelly clamps (hemostats)with you to use as mini-pliers. Grasp the cap with one and the hub (NOT the tube itself) with the other Kelly clamp and twist.
Before attaching the syringe to the cap, I first pull back on the syringe a little bit to unstick the plunger and then push the plunger to remove any air.
Using the remainder of the saline in the syringe, flush vigorously in spurts of 2-3 mls at a time. This produces turbulence inside the catheter and clears it out. I know the video says slowly, but vigorous is better.
In most cases you will have pre-filled syringes with 10 mls of NSS (Normal Saline Solution). However, if perchance you have to draw up your own syringe remember not to use a syringe smaller than a 10mls. The smaller the barrel of the syringe the greater the pressure and you don’t want to blow out the wall of the PICC.
Some institutions have nifty little orange alcohol caps that you can put over the cap to clean and leave on until the next time you have to access the IV.
Honestly, the hardest part of this procedure is getting the syringe pushed into the cap and screwed on.
PICCs with clamps do not need to be closed if there is the typical positive pressure cap you see in this video. Central lines are clamped.
Little story: I had one patient that swore she tasted chocolate every time the line was flushed. Not bad for 10 mls of NSS, eh?
If there is resistance, first check the clamp to make sure it is open and check there are no kinks in the line. Especially since PICC lines are so thin they can easily kink at the insertion site. Sometimes a little gentle traction on the line can remove a kink. Just be sure you aren’t pulling it out of the arm at all.