Groshong Catheter: Information, Care and Maintenance, and Complications

The Groshong catheter is the valved member of the tunneled central catheter family. Its defining feature — a closed tip with a pressure-sensitive three-way valve — changes how it is locked (saline only, no heparin) and how it is cared for (no clamp). This guide brings the Groshong to parity with our Hickman and Broviac guides: what it is, indications, care, complications, and how to choose between them.

Parent guide: Tunneled Central Venous Catheters (Hickman, Broviac, Groshong) · Central Venous Catheters: Complete Reference

What Is a Groshong Catheter?

A Groshong is a soft silicone central venous catheter with a rounded, closed distal tip. Just behind the tip is a patented three-way slit valve that responds to pressure:

Positive pressure (flushing/infusing) → the valve opens outward to deliver fluid.
Negative pressure (aspirating) → the valve opens inward to allow blood withdrawal.
Neutral pressure (at rest) → the valve stays closed, preventing blood reflux and air entry.

Because the valve — not a clamp — controls reflux, the Groshong needs no clamp and is locked with saline only. Groshong technology is available as both tunneled catheters and Groshong-valved PICCs.

Groshong vs. Hickman vs. Broviac

Feature	Groshong	Hickman	Broviac
Tip	Closed, valved	Open-ended	Open-ended
Clamp needed	No	Yes	Yes
Lock solution	Saline only	Heparin 100 u/mL	Heparin 100 u/mL
Best for	Heparin allergy/HIT; simpler care	Adult long-term, high-flow	Pediatric/neonatal, small adult

Indications

Groshong catheters are chosen for the same long-term central access needs as other tunneled catheters — home TPN, long-term antibiotics, chemotherapy, frequent draws — with a particular advantage when:

The patient has a heparin allergy or history of HIT.
A simpler, clamp-free, saline-only maintenance routine is desired (e.g., some home-care settings).

Care and Maintenance

The three maintenance tasks mirror other central lines, with valve-specific differences:

Flushing and locking

Flush each lumen with normal saline before and after use (SASH becomes SAS — no heparin).
Lock with saline only. No heparin and no clamp are required.
Scrub the hub for 15 seconds and allow it to dry before every access.

Exit-site care

Daily sterile dressing changes for the first 2–4 weeks until the Dacron cuff heals, then weekly per policy.
Clean with 2% CHG/alcohol; inspect the exit site and palpate the tunnel each change.

Protecting the catheter

Secure the external segment; keep the dressing intact and dry. A clamp is not used routinely, but keep one available in case of catheter damage.

Complications

Complication	Recognition	Management
CLABSI	Fever/rigors with use, positive cultures	Cultures, antibiotics; removal for confirmed CLABSI
Exit-site / tunnel infection	Local redness/drainage, or tract tenderness	Antibiotics; tunnel infection usually requires removal
Withdrawal occlusion (valve)	Flushes but won’t aspirate	Reposition; thrombolytic per protocol; assess valve/fibrin sheath
Occlusion	Won’t flush or aspirate	Alteplase per protocol; do not force
Thrombosis	Arm/neck/facial swelling	Imaging; anticoagulation
Dislodgement / breakage	Increased external length; leak	Reassess position; repair/replace

For workups see Catheter Occlusion Management and Catheter Complications.

Removal

Like other tunneled catheters, the Dacron cuff is fibrosed into the tunnel; removal frees the cuff by traction or a small cut-down and follows standard air-embolism precautions. See Central Line Removal Procedure.

References

Gorski LA, et al. (2021). Infusion Therapy Standards of Practice (8th ed.). Journal of Infusion Nursing, 44(Suppl 1), S1–S224.
Hoffer EK, et al. (1999). Prospective randomized trial of valved versus nonvalved peripherally inserted central catheters. American Journal of Roentgenology.
O’Grady NP, et al. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162–e193.

Frequently asked questions

What is a Groshong catheter?

A Groshong catheter is a tunneled (or PICC-style) central venous catheter with a closed, rounded tip and a patented pressure-sensitive three-way valve on the side. The valve opens outward to infuse, opens inward to aspirate blood, and stays closed at rest — which prevents blood reflux without a clamp and allows the catheter to be locked with saline only, no heparin.

How is a Groshong catheter different from a Hickman?

Both are tunneled central catheters, but the tip design differs. A Hickman (and Broviac) is open-ended, so it needs a clamp and a heparin lock to prevent blood reflux and clotting. A Groshong has a closed tip with a pressure-sensitive valve, so it needs no clamp and is locked with saline only. The Groshong is especially useful for patients with heparin allergy or heparin-induced thrombocytopenia (HIT).

Do you flush a Groshong catheter with heparin?

No. Because the pressure-sensitive valve keeps the catheter closed at rest and prevents blood reflux, a Groshong is flushed and locked with normal saline only — no heparin is required. This is the main practical advantage of the Groshong valve and the reason it is chosen for patients who cannot receive heparin.

How often is a Groshong catheter flushed?

A Groshong is flushed with normal saline after each use and, when not in use, typically at least weekly per institutional policy (some valved PICCs are flushed weekly to monthly). Use a 10 mL-barrel syringe and pulsatile technique. Always scrub the hub before access.

What are the complications of a Groshong catheter?

Groshong complications are the same as other central catheters: CLABSI, exit-site or tunnel infection, occlusion, catheter-related thrombosis, dislodgement, and breakage. The valve reduces reflux-related clotting but does not eliminate occlusion; a malfunctioning valve can also cause withdrawal occlusion (flushes but won’t aspirate).