SASH Technique - Saline Antibiotic Saline Heparin

I recently helped my uncle recover from an infection and I wrote down these notes. Hopefully they are helpful for others. It's important to note that I am not a medical expert. These are my notes and you should check with your own doctors or nursing folk to make sure this is correct.

The following is a detailed step-by-step procedure about how to deliver antibiotics using the SASH technique (Saline Antibiotic Saline Heparin). You should have 3 syringes (2 saline and 1 heparin) and the antibiotic pouch. You will need 4-5 alcohol towelettes and maybe a picc line cap if you are replacing it.

It is critical to wash hands beforehand, use rubber gloves carefully, and follow the alcohol towelette instructions to keep the picc line from getting infected.

1. Take the antibiotic pouch out of the fridge an hour before the procedure so it can warm up.
2. Each syringe has an air bubble at the top that needs to be removed. Take off the cap from the syringe, hold the syringe with the end up, draw in some air, then slowly push it out until the air bubble has been removed. Do this initially for one of saline syringes (maybe white color).
3. The antibiotic pouch has a line coming out of it. Remove and dispose of the end of the line and uncrimp the line over a garbage can until drops flow out meaning that all air is out of the line. Recrimp it.
4. Roll back any mesh sleeve that the patient has to secure the picc line. Ours was fiddley so take your time here.
5. Take off the cap from the picc line (if any) and either discard or carefully put down on an alcohol pad to preserve its cleanliness if you are reusing it.
6. Open the catheter clamp which is often a little slider that pinches the picc line.
7. Wipe the end of the picc line end with an alcohol towelette for ~20 seconds. Let dry for 10 seconds.
8. Do the first of 2 saline syringes (maybe white color) to flush the line. Hook up the syringe to the picc line by holding the end of the picc line and carefully pushing in the syringe while screwing it in.
9. Push the syringe plunger with little pushes slowly to push the saline into the picc line. If it is hard to push then the line may be crimped somehow that needs to be resolved maybe by straightening the arm and making sure the picc line is straight. When done, unscrew the empty syringe and discard.
10. Wipe the end of the picc line with an alcohol towelette for ~20 seconds. Let dry for 10 seconds.
11. Hook up the antibiotic pouch to the picc line. Uncrimp the pouch line. Pull the mesh back over the end of the picc line if so the patient can use their arm. The pouch should then compress as the antibiotics flow into the picc line over the next ~90 minutes. If it is a gravity feed then keep the pouch well above the patient. Keeping the arm straight is important maybe by putting a rolled up towel under the elbow. Stop when the pouch is empty. Clamp when done and discard.
12. Wipe the end of the picc line with an alcohol towelette for ~20 seconds. Let dry for 10 seconds.
13. Take the bubble out of the 2nd saline syringe (maybe white color), screw it into the picc line, and push it in with the same little pushes technique. When done, unscrew and discard.
14. Wipe the end of the picc line with an alcohol towelette for ~20 seconds. Let dry for 10 seconds.
15. Take the bubble out of the heparin syringe (maybe yellow color), screw it into the picc line, and push it in with the same little pushes technique. When done, unscrew and discard.
16. If you are reusing the picc line cap, wipe the end of the picc line with an alcohol towelette for ~20 seconds. Let dry for 10 seconds.
17. Put on the picc line cap.
18. Slide the catheter clamp on.
19. Replace any mesh sleeve that the patient has to secure the picc line.

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