How to Tell the Difference Between Open and Closed-Ended PICCs
First things first. What is a PICC line?
PICC stands for Peripherally Inserted Central Catheter. They’re used for direct access to larger blood vessels in the body. Patients have PICC lines inserted if they are going to be receiving large amounts of IV medication, volatile medications (like heavy-duty antibiotics), or will be receiving medication for a long period of time.
PICC lines are unique because they are inserted peripherally, meaning from the arm. The catheter extends all the way up the vessels in the arm up to the heart.
There is an abundance of information about PICC line care on the internet, but it’s hard to decipher whether a PICC line is open-ended or closed-ended. To tell between the two just by looking:
Look For the Clamp.
- If it’s an open-ended PICC, there will be a clamp.
- If it’s a closed-ended PICC, there will be no clamp.
Why? Here’s the Explanation:
Imagine the PICC line inside the body. It is a thin rubber-like catheter. The most important part is the end of it.
An open-ended PICC has an opening at the end, which allows fluid and medications to be pushed in, and blood to be drawn out. You can imagine that it looks like a garden hose: tubular, with an open end.
A closed-ended PICC instead has a thin slit-like valve on the side that provides the same function. The end is not open. In fact, it looks like a cone, or can be smooth like the front end of an airplane.
What’s the Difference?
The Open-Ended PICC creates turbulence as blood passes by it.
Since the tip is not smooth, blood does not flow past it very easily. The problem is, turbulence causes blood to clot inside the vessel. A clotted up PICC line is the worst kind of PICC line. To prevent clotting, these types of PICC lines need to be heparinized. (That means a saline flush followed by a heparin flush after use. Heparin, an anticoagulant, prevents blood from clotting.)
On the other hand, the smooth, more “aerodynamic,” tip of the closed-ended PICC facilitates blood flow, and thus does not need a heparin flush.
Why is there a clamp?
The closed ended PICC has a valve, so it does not need a clamp. A valve lets fluid in one way, but not the other. The “slit” on the side of the catheter is specially made to let fluid out of the catheter, but not let blood flow in.
An open ended PICC, on the other hand has no valve. Nothing is stopping blood from getting into the catheter. So, in order to prevent that, a clamp shuts off fluid movement (much like clamping a drinking straw traps whatever fluid is inside. Nothing comes in, nothing gets out.)
What is a Groshong PICC?
You may have heard of these. It’s very simple. Groshong is a trade name for a closed ended PICC. A Groshong is a closed ended PICC.
Just look for the clamp!
Happy Documenting, Nurses!