How to Tell the Difference Between Open-ended and Closed-ended PICCs

How do you tell between an open-ended vs close-ended PICC, just by looking? I was finishing up my first admission at work yesterday (way past the time my shift ended, may I add), and ran across this problem.

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.

So back to the first question. How do you tell what kind of PICC it is with your naked eye?

Just look for the clamp!

  • If it’s 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:

  1. An open-ended PICC has an open end, which allows fluid and medications to be pushed in, and blood to be drawn out.
  2. A closed-ended PICC instead has a thin slit-like valve on the side that provides the same function.

Here’s an (overly simplified) image of what I imagine it looks like:

 

A sketch demonstration of the difference between an open and closed-ended PICC

A sketch demonstration of the difference between an open and closed-ended PICC

 

What’s the difference?

The Open-Ended PICC creates turbulence as blood passes by it.

You can see from the sketch that it’s not a smooth tip. And what does turbulence cause? Clotting! 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.

What’s a Groshong?

A trade name for a closed-ended PICC. A Groshong is a closed-ended PICC.

How do you tell the difference with your own two eyes?

Again:

Just look for the clamp!

  • If it’s open-ended PICC, there will be a clamp.
  • If it’s a closed-ended PICC, there will be no clamp.

That’s it! Anyone else have any ideas? Write a comment below if you know anything more about differentiating PICC lines based on what you can see on the outside.

 

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