Starting a PICC or Broviac Hickman CVL

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This resource will help you start an infusion of medication or home parenteral nutrition (HPN). You'll do this before giving medications or HPN through a PICC or Broviac Hickman CVL.  

What you need

• sterile 4 X 4 gauze
• 10 ml prefilled 0.9% Sodium Chloride syringe
• 70% alcohol swabs
• new primed tubing
• non-sterile gloves

Instructions

• Assemble equipment and wash hands.
• Apply non-sterile gloves
• Remove the pre-filled 0.9% Sodium Chloride syringe from the package. Remove the white cap and remove all air bubbles from syringe. Recap syringe.
• Open the package of sterile gauze and alcohol swabs. Place swabs on sterile gauze
• Use 4 X 4 sterile gauze to grasp IV connector cap. Clean end of the IV connector cap with chlorhexidine swab for 15 seconds. Allow to dry 15 seconds. 70% alcohol needs at least 15 seconds cleaning time to be most effective. Air drying prevents the cleaning solution from getting into the valve
• Remove the white cap from the pre-filled 10 ml 0.9% Sodium Chloride syringe. Attach the syringe to the connector port. Unclamp the Broviac/ Hickman CVL or PICC line. Using light pressure pull back on to plunger to check for blood return. Then flush rest of the 0.9% Sodium Chloride to clear the line using turbulent flush. 
  • Watch for any resistance, pain, discomfort or leakage of fluid around the CVL.
  • Turbulent flush will help to clear the CVL of any fibrin or debris that may be sticking to the wall of the catheter.
  • If there is no blood return, heparinize the CVL with the required amount of heparin and contact your home care provider.
• Remove the syringe and connect new primed tubing.
• Start the pump.
• Dispose of equipment in appropriate receptacles.