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Learning Objective 1: Explain how internal and external positive pressure valves are designed to prevent clots within peripherally inserted central catheters.
Learning Objective 2: Describe how nurses can test the effectiveness of technology, specifically positive pressure valves, in a clinical setting.
Background: Heparin is used to prevent clots in peripherally inserted central catheters (PICCs), but can lead to heparin induced thrombocytopenia (HIT), a life threatening, autoimmune disorder that causes widespread clotting in susceptible people. Manufacturers have developed internal and external positive pressure valves that prevent blood from backing up into the PICC and are flushed with saline, not heparin. The internal valve is in the PICC itself and the external valve is connected to the PICC. The purpose of this study was to compare the effectiveness of internal and external valves, with and without heparin, in preventing clots.
Methods: A convenience sample of 58 subjects from 3 medical-surgical units was randomly assigned to one of three groups. Two groups had PICCs without an internal valve; PICCs in Group 1 were flushed with heparin and saline and those in Group 2 were flushed with saline alone. PICCs in Group 3 had an internal valve and were flushed with saline only. All three groups had an external positive pressure valve connector and all PICCs were inserted by the PICC team. A research nurse assessed every PICC daily for signs of occlusion or infection and TPA was used to reestablish the patency of any occluded lines. The study was approved by the hospital IRB.
Findings: The combination of an external positive pressure valve and saline flush was effective for preventing clots. Clots rates increased when PICCs had both an external and internal positive pressure valve. The PICCs without an internal valve (Groups 1 & 2) had a clot rate of 4/38 (10.5%) compared to 8/20 (40%) for PICCs with an internal valve. There were no significant differences in clotting rates when the PICCs without an internal valve were flushed with either heparin or saline.
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