in today's video we are looking at how to access your picc line you may be
needing to do a patency check or to administer medications so we are going
to go over the process for that right after this welcome back my name is Tammy
and this is nurse minder and on this channel we do everything nursing so if
you're new here consider subscribing below so that you get the next video
when it's released patency checks are required prior to infusing medications
or infusions or at least every 24 hours if they're not accessed to help us
remember the process we use the acronym SASS the first is a saline flush followed
by your medication administration your sodium citrate. If you're not using
sodium citrate, you might be using heparin in which case we can use SASH. So
if you remember the first step is to do a saline flush, so we're just going to
prepare our saline here. Now every time we access a PICC line we need to
actually cleanse it with the alcohol swab or chlorhexidine swab for at least
15 seconds. This is to help prevent the introduction of microbes into the
bloodstream. Don't forget to use some friction and to really get around that
entire hub there to make sure it is clean to prevent any contamination. We'll
let this air dry getting my saline ready here I'm just going to prepare my
syringe by removing the air, and then to attach with a push and twisting motion.
Now we want to unlock the line so that we can infuse our Saline. We're first
going to put in 2 mls of saline with a gentle pressure. After those 2 mls are
in we are actually going to pull back now and look for a flash of blood in our saline
and this is telling us that the line is patent; and there we have it. Now we can
go ahead and infuse the remainder of our saline using a pulsing pressure and in
your last one ml you want to be clamping off the lock. Now if it feels
like you need to force this fluid then you may have a positional line or a
partially clotted line and you'll want to stop the procedure and troubleshoot
it. Now that I've disconnected my saline I need to cleanse the line or I need to
cleanse the port again before I can attach my medication. So again a 15
second scrub using an alcohol swab or a chlorhexidine swab; using friction to
help remove any microbial or bacteria that are on the cap.
We let this air dry and we prepare to secure our medication or our infusion
line into the neutral cap with again a pushing and twisting motion and now
we're ready to start our infusion. Now don't forget to unclamp the line so that
your infusion can go through and of course we don't want this line just
hanging and dangling from the bed so we're going to secure it to our
patient's arm with a piece of tape. Okay so now the infusion is complete we're
going to continue on with our acronym of SASS or SASH. We've completed the first
two steps we had a saline flush and we administered our medications. Now we're
going to continue with the second saline flush and a sodium citrate to lock off
the line. Now I'm going to combine this with a cap change. This is done every 96
hours, after blood work is drawn, or when it looks contaminated. Now if you're not
needing to do a cap change at this time simply go ahead and follow the process
without the cap. So the supplies I need for this are my cap, my saline flush, and
my sodium citrate or heparin;vdepends on what your facility is using to lock. I'm
going to lock off my line now that the medication is completed or the infusion
is done and simply detached my line. The neutral connector is still connected to
the PICC line at this moment. The next step is to prepare my cap; so we're just
getting the Saline ready and we're going to prime the cap prior to changing the
cap and this removes any air bubbles so from sterile tip to sterile tip I can
attach the two and gently push forward my saline until it is primed. Can you
guess what's happening next? If you said a 15 seconds scrub you would be correct but
this time we're going to focus a little lower and we're going to actually
cleanse off the area where the cap will detach from the catheter. Again a good 15
seconds scrub here, use some friction to get rid of any bacteria. Again once
that's done we're going to let this air dry. While that's drying I'm going to
gather up my syringe that has the cap attached, remove the sterile blue end,
keeping this end sterile, I'm now going to use my thumb and index
finger to remove the old cap and simply screw on the new cap. Now I can go ahead
and instill this 10cc after unlocking my line. I do not need to look for blood
flashback because I've already checked patency prior to my med admin. Simply
administer using a pulsating pressure and lock off your cap in the last ml of
fluid infusion. After detaching the saline syringe only, you are now left
with the new cap; but there's still one more step. We need to lock the line to
make sure it doesn't clot so again a 15-second scrub is needed here; even
though we have just put on a brand new cap. So just in case you haven't heard it
enough, every time we access we need to clean to
prevent contamination into the blood stream because this PICC line is
actually sitting in the superior vena cava, just as it enters into your heart.
So again when this 15-second scrub is done we're gonna let it air dry,
and then we can get our sodium citrate or your heparin prepared. Removing the
cap, keeping sterile to sterile, we will insert and turn, and we're ready to
instill. Unlock your line and you can start to infuse your sodium citrate or
heparin, preparing to lock off that line in the last 1 ml of infusion. Remove
your sodium citrate and you are complete. And there you have it you now have the
steps to access your PICC line for safe medication infusion and patient safety
checks. Until next time make it a great day