Many patients require the use of a peripherally inserted central catheter (PICC) as they continue to heal. Doctors, nurse practitioners (or physicians assistants) insert PICC lines for patients who need IVs for a certain amount of time. These long lasting IVs are much better for patients than the traditional IVs. Nurses must make sure that the dressing on a PICC line is always clean and free of debris. This is a very important nursing skill that will become more and more important as PICC lines are used more and more often in the medical industry.
What is a PICC Line
A peripherally inserted central catheter or PICC line is a soft plastic tube that is inserted into a large vein right above the patient’s heart. The PICC line must remain sterile at all times so that the patient does not run the risk of getting an infection.
How Often are PICC Line Dressings Changed
PICC lines should be changed at least once per week. If the dressing becomes loose, wet, or dirty, the dressing must be changed more often to prevent infection. PICC line dressings must be inspected on a daily basis. Moist dressings are breeding grounds for infections. Signs of moisture, wetness, or dirt are signs that the dressings need to be changed more often. Loose fitting PICC line dressings can make it possible for dirt and debris to enter the area around the insertion site.
Steps on How to Change a PICC Line Dressing
The old dressing must be removed before applying new PICC line dressing so nurses must make this the first step of the changing process. Gather the necessary materials (biopatch, alcohol wipes, plastic wrap or aluminum foil, soap, and dressing kit) and get started.
- Clean the work area with alcohol pads or soap and water to sterilize the work area. Place aluminum foil or plastic wrap over any work area made of wood.
- Wash the hands thoroughly with soap and water for a minimum of 15 seconds. Make sure that the hands are dry before proceeding.
- Using the alcohol pads, lightly rub the pads over the patient’s old pads and dressing.
- Take care when removing the old tape that secures the old dressing.
- Make sure that the hub of the PICC line is held down securely on the arm so that it is not removed accidentally. Gently loosen the edges of the dressing and slowly pull it toward the site of the insertion.
- Examine the site and the skin for pain, swelling, pus, leaking fluid, torn skin, redness, or a protruding tube. Call the contact person or cover the area with sterile gauze and immediately take the patient to the ER.
Now that the old dressing has been removed, it is time to put on new dressing for the patient. The steps are as follows:
- Wash the hands again before proceeding to put on the new PICC line dressing.
- Open the package of a new dressing kit. Do not attempt to gather the materials contained in the package separately because there is no guarantee that the material will meet the same standards as those contained in the sterile dressing package. Tear the package at the corner and make sure that none of the materials is touched with the bear hands.
- Put on a pair of sterile gloves before touching any materials in the package. The dressing package contains a pair of sterile gloves in which the inside cuff of one glove is turned up so that the materials in the kit remain sterile. Do not touch the outside of the package or anything other than the contents of the package once the gloves are on the hands.
- Squeeze the sides of the Chloraprep stick contained in the package and clean the site using a circular motion. Begin sterilizing at the insertion site and work in an outward motion. Some kits may contain betadine or alcohol to sterilize the area.
- Allow the area to dry on its own for at least 30 seconds. Apply a BioPatch disk to the area around the PICC line, making sure the foam side is on the skin and the grid side is up. Line up the tubing and the slit. Cover the insertion site and patch with clear dressing.
- Secure the clear dressing by applying the tape in a criss-cross formation.
- Dispose of the used supplies and wash the hands when the process is complete.
Video on How to Change a PICC Line Dressing (Central Line Dressing)
Complications You May Encounter When Changing a PICC Line Dressing
The complications that are associated with changing PICC line dressing are catheter breakage due to improper care, infections, and leakage. It is also possible to pull the PICC line out accidentally while changing the dressing. Consult with the patient’s doctor immediately if this happens.
Infections are probably the biggest complication so it is important to monitor the dressing at least once per week and change the PICC line dressing whenever it gets dirty, loose, or wet.
Changing PICC line dressing takes patience and skill in order to do correctly. Patents depend on the care that nurses provide to make sure that their PICC line care is executed properly.