Is it normal to hear and feel a flushing sound with a Peripherally Inserted Central Catheter (PICC) line?

Hearing and Feeling a Flushing Sound with PICC Line

It is not normal to hear or feel a flushing sound with a properly functioning PICC line, and this symptom warrants prompt evaluation as it may indicate catheter malposition or other complications. 1, 2

Potential Causes of Flushing Sounds with PICC Lines

• Catheter tip malposition, particularly when the tip is located in the upper or middle third of the superior vena cava rather than the recommended position at the cavoatrial junction 1
• Mechanical issues such as catheter kinking, fibrin sheath formation, or partial occlusion that may cause turbulent flow during flushing 1
• Possible catheter damage or early signs of rupture, which is one of the serious complications associated with PICC placement 3
• Improper flushing technique using excessive pressure or small syringes (less than 5mL) that generate higher pressure 2

Immediate Assessment and Management

• Check for external causes of resistance such as kinks in the catheter or patient positioning issues that might be contributing to the unusual sound 2
• Verify PICC tip position through radiographic assessment if the sound persists, as tip location in the upper SVC or subclavian/innominate veins is associated with higher complication rates 1
• Assess for signs of thrombosis, which occurs in 4-8% of cases and can cause partial occlusion leading to unusual sounds during flushing 1
• Evaluate catheter patency by attempting gentle aspiration and flushing with 10mL of normal saline using proper technique 1, 2

Proper PICC Maintenance to Prevent Complications

• Use normal saline for routine flushing rather than heparin, as both are equally effective in maintaining catheter patency 1
• Employ proper flushing technique using a 10mL or larger syringe with turbulent push-pause method to prevent catheter damage 2
• For PICCs not in active use, perform regular flushes according to institutional protocols (typically weekly) to maintain patency 2
• Ensure the catheter tip is properly positioned in the caudal SVC or cavoatrial junction to minimize complications 1

When to Seek Immediate Medical Attention

• If the flushing sound is accompanied by pain, swelling, or redness at the insertion site, which may indicate thrombosis or infection 1
• If resistance is felt during flushing or if blood cannot be aspirated from the catheter, suggesting partial or complete occlusion 1
• If the patient experiences any systemic symptoms such as shortness of breath, chest pain, or palpitations during flushing, which could indicate serious complications 1
• If the catheter appears damaged or if there is leakage around the insertion site 3

Prevention of Future Complications

• Use single-lumen PICCs when possible, as the risk of thrombosis increases with the number of catheter lumens 1
• Consider right-sided placement when possible, as left-sided placements are associated with higher incidence of deep vein thrombosis 1
• Ensure proper patient education about PICC care and potential complications to improve early recognition of issues 4
• Maintain strict aseptic technique during any manipulation of the PICC line to reduce infection risk 5

The presence of a flushing sound with a PICC line is an abnormal finding that should prompt evaluation to rule out catheter malposition or other complications that could affect patient morbidity and mortality if left unaddressed.