Download Care and Removal of Peripherally Inserted Central Catheters (PICC

Corporate Policy & Procedures
Care and Removal of
Peripherally Inserted Central
Catheters (PICC) for Adults
Approved by:
Vice President and Chief Medical Officer; and
Vice President and Chief Operating Officer
Purpose
•
•
•
•
Policy
Statement
Manual
Number: VII-B-305
Date Approved
July 7, 2014
Date Effective
July 11, 2014
Next Review (3 years from Effective Date)
July 2017
To identify standards of care for patients with peripherally inserted central
catheters (PICC).
To act as a resource for staff so that errors leading to complications are reduced.
To identify and comply with current best practices from infection control and
infusion nursing standards.
To ensure that health care professionals who care for, maintain and remove
PICCs have education and demonstrated competency.
Only those health care professionals who have completed the required educational
program and have demonstrated competency will care for and/or remove Peripherally
Inserted Central catheters.
All PICC shall be reviewed daily for line necessity. Unnecessary lines will be removed
promptly.
Applicability
This policy and procedure applies to all Covenant Health facilities, staff, physicians,
volunteers, students and any other persons acting on behalf of Covenant Health.
Responsibility
Health care professionals who care for, maintain or remove PICCs must clearly
understand their indications for use and the potential for complications and adhere to
current evidence-based practices outlined herein.
Health care professionals shall demonstrate compliance with this policy and procedure
by:
• adhering to the education requirements
• ensuring that they understand the appropriate care and maintenance needed to
prevent infection/complication after the PICC is inserted
• provide proper care of the PICC post-insertion to preventing Central Line
Associated Blood Stream Infections (CLABSIs).
Principles
Knowledgeable and educated health care professionals reduce the risk of central line
associated blood stream infections and other complications
Using infection prevention maintenance bundles decreases central line associated blood
stream infections.
Indications for use of central venous catheters:
• Administration of medications, such as chemotherapy or antibiotics
• Administration of fluids, including blood components or blood products
• Monitoring of central venous pressure
• Providing parenteral nutrition
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
2 of 21
Advantages of PICCs are:
• reliable long term access (therapy from six days to one year)
• eliminates risk of pneumothorax
• suitable for vesicants and hyperosmolar solutions
• easily managed on an outpatient basis
Disadvantages of PICCs
• higher incidence of DVT
• small lumen size therefore not appropriate for high volume infusions/resuscitation
Requirements: See Demonstration Skills Checklists
Education /
• Performance Criteria StatLock™ PICC Dressing
Demonstrated
• Performance Criteria SecurAcath™ PICC Dressing
Skills
•
•
Definitions
Performance Criteria Every 96 hours Injection Cap change
PICC Removal Demonstration Checklist
For the purpose of this policy and procedure:
Scrub the hub means: Each time the injection cap is entered it must be cleaned with an
alcohol or chlorhexidine/alcohol wipe. Scrub the injection cap with the wipe for 15
seconds using friction and allow the solution to dry.
Catheter flush is a technique whereby the solution is pushed through the catheter into
the bloodstream (no dwell time)
Catheter lock is a technique by which a solution is injected into the catheter lumen dead
space until it is filled and then allowed to dwell for a period of time, until the catheter is
accessed again.
Health care professional means an individual who is a member of a regulated health
discipline, as defined by the Health Disciplines Act or the Health Professions Act, and
who practices within scope or role.
Related
Documents
Appendix A - PICC Dressing Change Principles
Attached Demonstration Skills Checklists:
• Performance Criteria StatLock™ PICC Dressing
• Performance Criteria SecurAcath™ PICC Dressing
• Performance Criteria Every 96 hours Injection Cap change
• PICC Removal Demonstration Checklist
Insertion of Peripherally Inserted Central Catheters (PICC)Policy (in development)
References
Alexander, M. (Jan/Feb 2011) Infusion nursing standards of practice. Journal of Infusion Nursing,
supplement, Vol. 34, #1S, S110.
Alexander, M., Corrigan, A., Gorski, L., Hankins, J., Perucca, R. Infusion Nurses Society: Infusion
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
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rd
Nursing: An evidence-based Approach. 3 Edition. 2010
Centres for Disease Control and Prevention. (2011). Guidelines for the prevention of intravascular
catheter-related infections, 2011. Self-published.
Doellman, D. et al (2009). Infiltration and Extravasation: Update on prevention and management.
Journal of Infusion Nursing. Vol. 32, No. 4.
Hadaway, L.(2007) Emergency: Infiltration and Extravasation: Preventing a complication of IV
catheterization. American Journal of Nursing. Vol. 107, No. 8.
Infectious Diseases Society of America. (April 1, 2011) Guidelines for the Prevention of
intravascular catheter-related infections. Oxford University Press. CID 2011:52 (1 May).
th
Infusion Nurses Society. Policies and procedures for infusion nursing. 4 edition. 2011
Registered Nurses Association of Ontario. (2004). Nursing Best Practice Guideline: Assessment
and Device Selection for Vascular Access
Registered Nurses Association of Ontario. (2005). Nursing Best Practice Guideline: Care and
Maintenance to reduce vascular access Complications
The Canadian Patient Safety Institute. Getting started kit; prevent central line infections. Central
line associated – blood stream infections. Safer healthcare now! Campaign. February
2012.
The Joint Commission, J Preventing central line-associated bloodstream infections: a global
challenge, al global perspective. Oak Brook IL: Joint commission resources, May 2012.
http://www.Preventing CLABSIs.pdf.
International evidence-based recommendations on ultrasound-guided vascular access. Intensive
care medicine, Published online 22 May 2012.
Thibodeau S. Riley J, Rouse K. Effectiveness of new flushing and maintenance policy using
peripherally inserted central catheters for adults. Best practice. Journal of Infusion Nursing.
2007;30(5):287-292
Hadaway L. Heparin locking for central venous catheters. Journal of Association for Vascular
Access. 2006; 11 (4): 224-231
Hadaway L. Misuses of prefilled flush syringes. Infection Control Resources. 2008;4(4):2-4
Casey AL, Elliot TS. Infection risks associated with needleless intravenous access devices. Nurs
Stand. Nov 21 2007; 22(11):38-44.
Field K, McFarlene C, Cheng A,et al. Incidence of catheter related bloodstream infection among
patients with a needleless, mechanical valve-based intravenous connector in an Australian
hematology-oncology unit. Infect Control Hosp Epidemiol. 2007;28(5):610-613
Maragakis L. Bradley K, Song X, et al. Increased catheter-related bloodstream infection rates after
the introduction of a new mechanical valve intravenous access port. Infect Control Hosp
Epidemiol. 2006;27(12):67-70.
Muslimani A, Ricaurte B, Daw H. Immune heparin-induced thrombocytopenia resulting from
preceding exposure to heparin catheter flushes. American Journal of Hematology. Dec 18,
2006 epub 2006
Previous
Version (date)
N/A
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
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PAGE(S)
1.0
INFECTION PREVENTION & CONTROL
…………………………………………………
5
2.0
PATIENT SAFETY
…………………………………………………
5-6
3.0
ENSURING PATENCY & FLUSHING PICC
…………………………………………
6-7
4.0
GUIDELINES FOR LOCKING PICC
…………………………………………………
4.1
Open-Ended PICCs
4.2
Close-Ended / Valved PICCs
7-8
5.0
INJECTION CAP CHANGE
8
6.0
PICC DRESSING CHANGE USING STATLOCK® SECUREMENT ……………………..
8-11
7.0
PICC DRESSING CHANGE USING SECURACATH ………………………………………
11-13
8.0
PATIENT ASSESSMENT
…………………………………………………
13
9.0
PATIENT TEACHING
9.1
For Inpatients
9.2
For Outpatients
………………………………… ………………
14
10.0
DOCUMENTATION
…………………………………………………
14-15
11.0
REMOVAL OF PICC
…………………………………………………
15-17
12.0
DOCUMENTATION OF REMOVAL
…………………………………………………
18
13.0
COMPLICATIONS
…………………………………………………
18-20
Appendix A - PICC Dressing Change Principles
………………………………… ………………
………………………………………….
21
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
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1.0 INFECTION PREVENTION & CONTROL
1.1
To minimize the risk of Central Line Associated Blood Stream Infection (CLABSI) associated with
direct contact of the hands of health care personnel, hand hygiene is to be performed at the
following times;
• before and after palpating the site of catheter insertion
• before and after inserting the catheter
• before and after accessing, replacing, repairing, or dressing the catheter
Aseptic technique is required for all instances of PICC care. Aseptic technique is also referred to
as sterile technique and is used to keep objects and areas free of microorganisms and thereby
minimize infection risk for the patient.
1.2
Strict aseptic technique is required for:
1.
administration set changes,
2.
dressing changes,
3.
injection cap changes.
1.3
Hands are to be cleansed with alcohol based hand sanitizer and clean gloves worn prior to
flushing, locking, handling administration sets, etc.
1.4
Sterile gloves and mask must be worn for dressing changes.
1.5
To maintain a “closed” system attach an injection cap (eg. split septum) to lumen ends. Attach
administration sets to the injection cap.
1.6
The external surface of a catheter hub, connector, or injection port is the immediate portal of entry
of microorganisms to the intraluminal surface of the catheter. Microorganisms entering the system
attach at any point of contact along the intraluminal surface. The colonizing organisms form within
the needleless connector, catheter hub, and lumen and can be dispersed into the bloodstream,
resulting in CLABSI. It is critical, therefore, that these surfaces be thoroughly disinfected with
chlorhexidine/alcohol wipe before they are accessed. Scrub the hub for 15 seconds and allow
solution to dry completely.
Scrub the hub: Each time the injection cap is entered it must be cleaned with an alcohol or
chlorhexidine/alcohol wipe. Scrub the injection cap with the wipe for 15 seconds using friction and
allow the solution to dry.
2.0 PATIENT SAFETY
2.1
Proper maintenance of PICC is essential for continued patient safety.
2.2
Daily assessment of line necessity:
2.2.1 Risk of CLABSI increases with the duration of time the catheter is left in place, so evaluation
of the continued need for a catheter is an important aspect of CLABSI prevention;
2.2.2 Catheters that are no longer needed should be promptly removed.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
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Policy No.
VII-B-305
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2.2.3 Daily review of the continued need for CVCs can be done during multidisciplinary patient
care rounds or by using reminders, such as stickers on patient records or order sets, or via
automated computer alerts.
2.3
NOTE:
Infuse all solutions, blood products, and medications via administration sets with luer lock
connections.
Do not take blood samples or insert a peripheral intravenous catheter in arm with PICC. If
no other site is available for blood specimen collection, the hand on the PICC side may be
used
Do not take blood pressure from arm with PICC as this can cause compression of catheter
which could lead to occlusion or severing of catheter. Post sign at patient’s bedside to alert
all hospital staff.
3.0 ENSURING PATENCY & FLUSHING PICC
NURSING ALERT:
All administration sets, extension tubing, or intermittent
injection caps attached to central lines must have luer lock
connections.
Always use a 10 cc syringe or large barrel syringe for flushing as
it has a lower pressure rating. Smaller syringes have greater
pressures and may rupture catheter. Once patency has been
confirmed small quantities of medication in syringes of appropriate
size for the dose may be administered.
3.1
Scrub the hub. Ensure catheter patency by using a syringe to withdraw and observe for blood
return, then flush to clear the catheter of blood. The catheter should flush without resistance or
leaking from insertion site. Flush with preservative free saline for injection to clear the line of
medications prior to locking. When flushing and/or locking, use “Positive Pulsing Pressure” by
giving short jerky pushes on plunger.
3.2
If unable to obtain blood return, or there is resistance to flushing, the nurse should take further
steps to assess patency (eg. is the clamp off?) If withdrawal occlusion observed, report it as soon
as possible because this is the optimal time to manage occlusions. All complete occlusions should
be managed or the catheter removed and replaced if still necessary. Refer to Corporate Policy
#VII-B-335, Occlusion Management of Central Venous Catheters).
3.3
Patency is confirmed at the following times:
• Continuous infusions: with injection cap / administration set changes and prn
• Intermittent infusions: prior to administration of flush solution / medication
• PICCs not in use: with daily locking solution administration.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
NURSING ALERT:
3.4
4.0
Date Effective
July 11, 2014
Policy No.
VII-B-305
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If IV solution does not readily infuse or lumen cannot be locked
without meeting resistance, DO NOT apply force in attempt to
free catheter of clot that may have formed. Occluded catheters
increase the risk of catheter related blood stream infections.
Notify physician and/or NP or designee to consider restoring
patency to occluded lumen or to replace catheter.
Frequency of flushing:
20 mL saline flush
• After blood sampling.
• Before and after blood component administration
10 mL saline flush
• When converting from continuous to intermittent therapies
• Before and after intermittent medication therapy
• For maintenance of dormant PICCs.
GUIDELINES FOR LOCKING PICC
4.1
Open-ended PICCs
4.1.1
Maintain the patency of each unused lumen by locking the catheter. Locking solutions
in order of preference are:
1.
2.
3.
3 mL Sodium citrate 4% in a 10 mL syringe
5 mL of heparin lock solution (10 units/mL) or, if not available,
3 mL heparin lock solution (100 units/mL) q24 or as ordered.
4.1.2. The volume should be at least twice the volume capacity of the catheter lumen plus the
priming volume of all add-on devices (eg. extension tubing).
4.1.3
To maintain the patency of catheters locked between medications follow SASS or
SASH:
o Saline to assess catheter patency
o Administration of medication
o Saline to flush medication out of catheter
o Sodium citrate or Heparin Lock to maintain patency between medication.
Heparin locking: Platelet count monitoring is recommended for post-op patients every
2-3 days from day 4 -14, or until therapy with heparin is stopped. A decrease in platelet
count may indicate Heparin Induced Thrombocytopenia.
4.1.4
If the PICC has a clamp, clamp before removing blunt cannula/syringe from injection
cap. Clamp the catheter when not in use with the clamp provided. Vary position of
clamp along lumen to prevent wearing of catheter lumen. If catheter has a clamp, it
must be clamped when not in use. If clamp has fallen off, if possible obtain
replacement clamp and attach to CVC extension.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
4.2
Date Effective
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Policy No.
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Closed ended / valved PICC’ (Groshong / Solo / Neutral displacement connector)
4.2.1
Maintain the patency of each lumen by locking with 10 mL of normal saline for injection
qweek or as ordered. Guidelines for locking:
• If using interlink system: Since the PICC doesn’t have a clamp, apply positive pressure
by withdrawing the blunt cannula while injecting the last 0.5 mL of normal saline.
• The volume should be at least twice the volume capacity of the catheter lumen plus the
priming volume of all add-on devices (eg. Injection cap, extension tubing).
5.0
4.3
Change equipment as outlined in Corporate policy #VII-B-330, Maintenance of
IV/Hypodermoclysis Equipment.
4.4
Indicate equipment and dressing changes in Kardex.
INJECTION CAP CHANGE
5.1
If catheter is open ended, air embolism is avoided by positioning the insertion site below the
level of the heart and clamping catheter prior to changing injection caps and/or extension sets.
If the clamp has fallen off, have the patient exhale while changing the cap. Replace clamp if
possible.
5.2
Cleanse the connection between the catheter hub and injection cap with antiseptic swab for 15
seconds. Using no touch technique, remove the old injection cap and replace with a new sterile
injection cap taking care not to touch the threads of the catheter hub or to contaminate the
threads of the new sterile cap. Some injection caps require priming prior to attaching to PICC,
therefore follow cap manufacturer’s directions. If threads of catheter hub are dirty, prior to
attaching new injection cap, cleanse hub threads with chlorhexidine alcohol wipe being careful
that cleansing solution does not enter catheter.
6.0 PICC DRESSING CHANGE USING STATLOCK® SECUREMENT
Equipment
• Sterile dressing tray
• Clean gloves
• Sterile gloves
• Chlorhexidine 2% /alcohol 70% swab sticks – 3 to 4 or more as appropriate
• Sterile skin barrier film (eg. CavilonTM No Sting Barrier Film)
• Transparent Dressing – use as many as required to ensure a minimum of 1 inch (or 2.5
cm) around insertion site and to cover the entire external portion of catheter, StatLock®
and catheter suture wing. Dressing choice may be a transparent film dressing or
transparent film which contains chlorhexidine/ antiseptic components as appropriate for
your area and the brand of PICC you are covering. Try to minimize the amount one
dressing overlaps another dressing.
• StatLock®.
• Mask
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
This is a PICC suture wing
Date Effective
July 11, 2014
Policy No.
VII-B-305
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This is a PICC extension hub
6.1
Perform hand hygiene. Assemble equipment. Don mask. Don clean gloves and use hospital
disinfectant to clean over-bed table or procedure table prior to opening sterile supplies. Remove
gloves. Perform hand hygiene.
6.2
Open sterile dressing tray and aseptically add dressing supplies to the dressing tray, being careful
to keep all supplies sterile. Note that the chlorhexidine swab sticks and barrier film swab stick
packages may be opened and arranged at the edge of the sterile field when clean gloves are used
for cleansing or sterile forceps may be used to transfer stick to sterile tray so they may be easily
retrieved with sterile gloves.
6.3
Don clean gloves. Gently and carefully remove transparent film dressing by supporting the skin
and the catheter with your fingers and either stretching the dressing laterally to break the adhesive,
or gently peeling back the dressing by folding the dressing back over itself. Do not pull the
dressing up from the skin because this may cause epidermal or skin stripping. Remove dressing
from the suture wing towards the insertion site. To aid in lifting a dressing edge, a piece of tape
may be used in a corner.
NOTE:
Use caution to ensure that PICC is not accidentally pulled out during dressing change when
StatLock™ is being replaced.
•
Anchor the catheter securely to avoid dislodgement when PICC not secured by
securement device.
•
Hold the suture wing with clean gloves at the time of StatLock™ removal and before
cleansing skin and external catheter.
IF THE PICC BECOMES DISLODGED, NEVER PUSH PICC BACK INTO VEIN.
6.4
Using a chlorhexidine/alcohol swabstick, remove the StatLock® from the skin by gently
inserting the swab tip under it and moving the swab tip back and forth in a see-saw motion to
dissolve the adhesive. Continue until the StatLock® is completely removed from the skin. Do
not pull it off the skin with force.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
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Note:
Either clean or sterile gloves may be worn when cleaning skin and external catheter. Hand
hygiene must occur prior to donning sterile gloves.
6.5
Using chlorhexidine / alcohol swabstick and using friction, cleanse skin around the insertion site
and skin that will be under the dressing in a back and forth, then up and down motion. An
application time of 30 seconds is required to kill bacteria on and within the layers of the skin.
Using new swabstick, cleanse along external catheter from insertion site up to and including
suture wing. Repeat using the other side of the swabstick, cleansing the underside of the
external catheter and suture wing. Ensure that clean gloves to not touch newly cleaned skin or
external catheter.
6.6
Let cleanser air dry completely. Drying time is usually two minutes, but may be much longer on
humid days or if preparations that do not contain alcohol are used.
6.7
Apply sterile skin barrier film (eg. CavilonTM No Sting Barrier Film) onto the skin, avoiding a 1 cm
area around the insertion site. Except for the area immediately around the insertion site, all skin
that will be covered by the dressing should be painted with the skin barrier film. Ensure that the
barrier film is completely dry before applying the dressing.
Exception: If using Tegaderm™ CHG IV Securement Dressing or Biopatch™, do not use a
barrier film to the area of antimicrobial delivery in order to allow penetration of the
chlorhexidine product. The chlorhexidine impregnated area should cover the insertion site.
6.8
Sterile gloves required. If wearing clean gloves, remove them, perform hand hygiene and don
sterile gloves. Place PICC suture wing into the new StatLock®, grasping PICC suture wing and
place suture holes over posts of StatLock device one side at a time and close lids one at a time,
while stabilizing the catheter and keeping finger under pad so that no pressure is applied to your
patient.
6.9
Without removing adhesive backing, position StatLock device on the arm so that PICC will not
kink with arm movement. Peel away the adhesive backing from the StatLock one side at a time,
adhere the device to the skin.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
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Policy No.
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6.10
Ensure arm is fully extended; apply transparent film dressing, being careful not to stretch the
dressing. Gently lay the film at the desired location, and using firm pressure, press the film
down onto the skin, working from the insertion site (middle of the dressing) toward the outside
border. Not stretching the transparent film prevents skin stripping and tension blisters on the
skin. Use as many transparent dressings as required to cover 2.5 cm around the insertion site,
the entire external catheter, the StatLock® device, and the catheter suture wing. Minimize the
overlap of dressings.
6.11
Label dressing with “PICC”, your initials and the date the dressing was changed.
PICC DRESSING CHANGE USING SECURACATH SECUREMENT
Equipment
• Sterile dressing tray
• Clean gloves
• Sterile gloves
• Chlorhexidine 2% /alcohol 70% swabstick – 3 to 4 or more as appropriate
• Sterile skin barrier film (e.g. CavilonTM No Sting Barrier Film)
• Transparent Dressing – use as many as required to ensure a minimum of 1 inch (or 2.5
cm) around insertion site and to cover the entire external portion of catheter, SecurAcath
and catheter suture wing. Dressing choice may be a transparent film dressing or
transparent film which contains chlorhexidine/antiseptic components as appropriate for
your area and the central venous catheter you are covering. Try to minimize the amount
one dressing overlaps another dressing.
• Mask
7.1
Perform hand hygiene. Assemble equipment. Don mask. Don clean gloves and use hospital
disinfectant to clean over-bed table or procedure table prior to opening sterile supplies.
Remove gloves. Perform hand hygiene.
7.2
Open sterile dressing tray and aseptically add dressing supplies to the dressing tray, being
careful to keep all supplies sterile. Note that the chlorhexidine swabstick and barrier film
swabstick packages may be opened and arranged at the edge of the sterile field when clean
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
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gloves are used for cleansing or sterile forceps may be used to transfer stick to sterile tray so
they may be easily retrieved with sterile gloves.
7.3
Don clean gloves. Gently and carefully remove transparent film dressing by supporting the skin
and the catheter with your fingers and either stretching the dressing laterally to break the
adhesive, or gently peeling back the dressing by folding the dressing back over itself. Do not
pull the dressing up from the skin because this may cause epidermal or skin stripping. Remove
dressing from the hub towards the insertion site. To aid in lifting a dressing edge, a piece of tape
may be used in a corner. Remove gloves.
Note: Either clean or sterile gloves may be worn when cleaning skin and external catheter. Hand
hygiene must occur prior to donning sterile gloves.
7.4
If blood is present on SecurAcath device, use saline soaked gauze or dry gauze to remove the
blood. If touching unsterile extension use sterile dry gauze to protect sterile gloves. Gently lift
the catheter and SecurAcath device, using chlorhexidine/alcohol swabstick, and using friction,
clean around the catheter insertion site. Cleanse the insertion site and skin that will be under
the dressing in a back and forth motion. Repeat using the other side of the swabstick then
cleanse in an up and down motion. An application time of 30 second is required to kill bacteria
on and within the layers of the skin.
7.5
Using new chlorhexidine/alcohol swabstick, cleanse along external catheter from insertion site,
soak the SecurAcath device, and then cleanse up to and including the suture wing. Repeat
using the other side of the swabstick, cleansing the underside of the external catheter,
SecurAcath and suture wing. Let cleanser air dry completely. Drying time is usually two
minutes, but may be much longer on humid days or if preparations that do not contain alcohol
are used.
7.6
Apply sterile skin barrier film (e.g. CavilonTM No Sting Barrier Film) onto the skin, avoiding a 1
cm area around the insertion site. Except for the area immediately around the insertion site, all
skin that will be covered by the dressing should be painted with the skin barrier film. Ensure
that the barrier film is completely dry before applying the dressing.
Exception: If using a Tegaderm™ CHG IV Securement Dressing or Biopatch™, do not use a
barrier film to the area of antimicrobial delivery in order to allow penetration of the
chlorhexidine product. The chlorhexidine impregnated area should cover the insertion site
and sutures if any.
7.7
Ensure that the SecurAcath device is not twisted or rotated because this causes pain.
SecurAcath will automatically fall into a comfortable neutral position.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
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Date Effective
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Policy No.
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7.8
Fully extend arm and apply transparent film dressing, being careful not to stretch the dressing.
Gently lay the film at the desired location, and using firm pressure, press the film down onto the
skin, working from the insertion site (middle of the dressing) toward the outside border. Not
stretching the transparent film prevents skin stripping and tension blisters on the skin. Use as
many transparent dressings as required to cover 2.5 cm around the insertion site, the entire
external catheter, the SecurAcath ® device, and the catheter suture wing. Minimize the overlap
of dressings.
7.9
Label dressing with “PICC”, your initials and the date the dressing was changed.
PATIENT ASSESSMENT
8.1
Assessment requires observation for systemic complications as well as observation and
palpation of insertion site moving proximal up the catheter route. Observe the catheter and
insertion site for:
•
•
•
•
•
•
•
Edema / swelling of hand, arm or dilated chest vessels
Redness at site or colour differences between limbs
Tenderness along PICC course
Drainage at site
Dislodgement / malposition or advancement of catheter
Unusual pain or sensations (neck pain, hearing the infusion)
Systemic signs or symptoms (see complications)
8.2
Report any of the above to the physician, NP or designee.
8.3
Site should be assessed every shift, pre-infusion, during infusion and immediately post-infusion.
NURSING ALERT:
Patients who have had a PICC line for a length of time may develop a
small amount of “scarring” around the catheter exit site. The skin will
become slightly reddened and raised without being irritated or
swollen.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
9.0
Date Effective
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Policy No.
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PATIENT TEACHING
9.1
For inpatients:
9.1.1
9.1.2
9.1.3
9.2
Reinforce to patient to notify nurse if pain – especially of shoulder of neck, edema,
unusual sensations, or redness at insertion site.
Apply digital pressure if bleeding from insertion site and call nurse.
Dressing must stay dry and intact
For outpatients:
9.2.1 Do not allow dressing to become wet.
9.2.2
Notify physician if any pain, edema or redness occurs to exit site, or if arm, chest or
neck pain is experienced on PICC side.
9.2.2
What to do in case of emergency (eg. short of breath)
9.3
Immediately after insertion apply warm compresses for 24 - 48 hours intermittently to upper arm
with catheter.
9.4
No blood work or blood pressure to arm with PICC.
9.5
Avoid excessive movement to arm with PICC. NO weightlifting or vigorous arm exercises.
Normal daily activities are acceptable.
9.6
Avoid tight fitting sleeves that may constrict arm.
9.7
Scissors or clamps should not be used to remove dressings or around IV site/tubing.
9.8
Avoid any pressure on inner surface area or axilla of cannulated arm. If using crutches, do not
press under arm with catheter.
10.0 DOCUMENTATION
10.1
Patient Care Record
Record
*
integrity of site
*
complications of catheter
*
status of infusion
*
dressing changes, observation of insertion site, sutures (if applicable)
10.2
Infusion Therapy Record
*
volume and type of solution
*
initiation and discontinuation of therapy
10.3
Medication Administration Record
*
locking solution
10.4
Kardex if applicable
*
dates of planned equipment changes;
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
15 of 21
i.e.
dressing change q7 days (eg. Oct. 9, 16, 23)
Injection cap changes q96 hours (Oct. 9, 13, 17)
11.0 REMOVAL OF PICC
11.1
Removal of PICCs with malpositioned tip location should be considered.
11.2
PICCs may be removed by physician/NP; or RN staff who have been observed by a clinical
educator, manager, or designate and have successfully completed the “Performance Criteria
Checklist for PICC Removal” may independently remove PICC lines
11.3
An order is required to remove a PICC. Ensure all IV medications/ solutions are discontinued
by the prescriber, or that alternate IV access has been established.
11.4
The nurse removing the catheter should be prepared to initiate emergency measures as
needed. Complications of removal include, but are not limited to:
•
Air embolism
•
Catheter embolism
•
Pulmonary embolism
•
Excessive bleeding
•
Resistance to removal.
11.6
Equipment
• protective gloves and mask
• petroleum impregnated gauze hydrocolloid dressing
• Sterile outer dressing
• sterile gauze
• chlorhexidine2% with 70% isopropyl alcohol swab. Sterile scissors, gloves and container
for C&S (if clinically indicated)
• Sterile scissors for SecurAcath removal
11.7
PROCEDURE
11.7.1
Check chart for order.
11.7.2
Perform hand hygiene. Assemble equipment. Don mask. Don clean gloves and use
hospital disinfectant to clean over-bed table or procedure table prior to opening sterile
supplies. Remove gloves. Perform hand hygiene.
11.7.3
Verify patient identity using two identifiers, and explains procedure to patient.
NURSING TIP:
Venospasm is often the cause of difficult PICC removal. The following may
prevent venospasm:
•
decrease fear by teaching patient that removal will not hurt
•
make sure patient is comfortable and relaxed
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
•
•
•
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
16 of 21
apply a warm blanket or compress to the upper extremity
encourage the patient to drink warm liquids
avoid excessive manipulation of PICC
11.7.4
Place patient in supine or seated position. Position patient arm abducted at a 45-90°
angle and the exit site below the level of the heart.
11.7.5
Perform hand hygiene. Aseptically open equipment. Don clean gloves.
NURSING ALERT:
Precautions should be taken to prevent air embolism when a PICC is
removed. Do not leave open to air post removal.
11.7.6
Remove dressing as per section 11.
11.7.7
Inspect exit site.
NURSING ALERT:
If purulent drainage at exit site, obtain swab for C&S from exit site. If
purulent drainage is noted at exit site or systemic infection is suspected,
following removal, cut approximately 5 cm of catheter tip with sterile
scissors, while not allowing PICC tip to touch skin or unsterile
equipment. Place tip in sterile container and send to lab for C&S.
11.7.8
Remove securement device from exit site.
Exception: PICC must be removed prior to SecurAcath removal. Follow
manufacturer’s direction for removal of SecurAcath at
http://www.interradmedical.com/removal
11.7.9
Cleanse exit site with chlorhexidine swabstick.
11.7.10 Beginning at the exit site, pull slowly until catheter is removed.
•
•
•
•
•
NURSING ALERT:
Do not apply pressure to exit site during removal.
Using gentle and even pressure, slowly pull the catheter out, keeping the catheter
parallel to the skin and re-grasping catheter at exit site as the catheter is removed..
Do not use force or apply tension. NEVER stretch the catheter.
If slight resistance is felt, pause to allow the vein to relax before continuing.
If firm resistance is encountered – STOP.
A PICC may resist removal because of venous spasm, vasoconstriction,
phlebitis, valve inflammation, or thrombosis.
To reduce the risk of catheter breakage and/or embolism, if firm
resistance is encountered during catheter removal:
•
Release the catheter; cover the exit site with a temporary sterile
dressing.
•
Try relaxation/distraction techniques with patient. Apply a warm
moist compress to exit site and upper arm for 30 minutes. Have
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
•
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
17 of 21
patient hold a warm object in the hand. After 30 minutes, attempt
catheter removal.
If catheter is still stuck, put sterile dressing on exit site and call
physician. Wait an additional 12 – 24 hours to allow spasm to
abate before attempting to remove catheter again.
11.7.11 Once PICC has been removed, apply digital pressure with sterile gauze to exit site until
hemostasis is verified (at least 30 seconds). Remove SecurAcath (if this is the
securement device used) as per manufacturer’s recommendation
11.7.12 Apply an air and water occlusive dressing over insertion site. This may be a
petroleum-based ointment/gauze that will seal the skin to vein tract and decrease the
risk of air embolus or sterile gauze topped by a hydrocolloid dressing such as
Comfeel® that prevents air or fluid entry under dressing
Examples of dressings are:
• Petroleum impregnated gauze dressings such as Adaptic™, Vaseline, Xeroform topped
with sterile gauze and transparent film
• Sterile gauze covered by hydrocolloid dressing.
Note:
Gauze and transparent dressing alone is not airtight. Change dressing daily until site
reepithelialised.
11.7.13 Inspect catheter for length and integrity. Compare the length to the recorded length in
the chart.
NURSING ALERT:
If the catheter is shorter than expected, save catheter (place in
biohazard bag) and call the physician immediately so that a follow-up
chest x-ray and physical examination can be done.
11.7.14 Dispose of PICC into biohazard container.
•
•
•
•
•
IN CASE OF CATHETER BREAKAGE:
Call for medical assistance immediately.
Check vital signs and pulses every five minutes.
Do not leave patient unattended.
Do not allow patient to ambulate.
Patient may be referred to an interventional radiologist or surgeon.
11.7.15 If catheter related blood stream infection is suspected, place sterile drape (from
dressing tray) in close proximity to catheter-skin junction. Remove catheter as
described above avoiding contact with surrounding skin. Using aseptic technique cut 5
cm of the catheter tip with sterile scissors and place in a sterile specimen container.
Label with patient name and send to the lab for culture and sensitivity.
11.7.16 Observe the patient for signs and symptoms of insertion site bleeding and air
embolism or pulmonary embolism (sudden onset of chest pain, dyspnea, unequal
breath sounds, decreased O2 saturations, cyanosis, hypotension, weak pulse,
decreased LOC, churning cardiac murmur).
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
18 of 21
12.0 DOCUMENTATION OF REMOVAL
12.1
13
Document removal procedure in patient record, indicating catheter integrity, if a swab or
catheter tip was sent for culture, site appearance, dressing applied, patient tolerance and if any
difficulties during removal were encountered.
COMPLICATIONS
COMPLICATION
SIGNS & SYMPTOMS
ACTION
PREVENTION
AIR EMBOLISM
*
*
*
*
*
*
coughing, chest pain,
respiratory distress, sob
cyanosis
altered level of
consciousness
*
*
*
stop infusion(s)
clamp or pinch catheter
(above damaged area)
patient to lie on left site in
Trendelenberg position
begin resuscitation
procedure if required.
Notify physician/NP
administer O2 monitor V/S
*
*
*
ARTERIAL
PUNCTURE
*
pulsating blood return
*
*
blood backing up into
tubing during infusion
*
*
Always clamp
catheter before
opening. Have
patient perform
Valsalva Manoeuvre.
Remove all air from
tubing and syringes.
Use leur lock
connections - ensure
they are tight.
Have non-toothed
clamp available.
apply pressure over
puncture site
begin resuscitation
procedures if required
notify physician/NP
immediately
*
Occurs inadvertently
during insertion.
BRACHIAL
PLEXUS
INJURY
*
tingling of fingers, pain
shooting down arm and/or
paralysis
*
notify physician/NP
*
Occurs inadvertently
during insertion.
CATHETER
OCCLUSION
*
Unable to aspirate blood –
withdrawal occlusion
unable to inject or infuse
solution – total occlusion
leaking of fluid or blood
from insertion site
*
attempt to aspirate then
attempt to flush the catheter
(do not apply force when
flushing)
notify physician/NP
manage the occlusion or
remove catheter
*
Use positive pulsing
pressure when
flushing/locking
Flush/lock lumens at
recommended
intervals.
Clamp catheter when
not in use for open–
ended catheters.
*
*
DAMAGED
CATHETER
*
leaking of fluid or blood at
damaged area
*
*
*
*
*
*
stop infusion
do not use catheter
clamp catheter with a nonserrated clamp proximal to
the damaged area
notify physician/NP
*
*
*
*
Never use scissors or
sharp objects around
catheter.
Use 10 mL syringes
or syringe barrels
manufactured to
reduce infusion
pressure (BD
Posiflush®) when
flushing to prevent
catheter rupture.
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
COMPLICATION
SIGNS & SYMPTOMS
Date Effective
July 11, 2014
ACTION
Policy No.
VII-B-305
PREVENTION
*
*
*
*
INFECTION
*
*
*
*
redness, pain, warmth,
swelling around exit site,
drainage (purulent,
discoloured)
fever and chills
generalized malaise
elevated WBC
*
*
do not use catheter
notify physician/NP
immediately
Obtain simultaneous
blood cultures from a
peripheral site and
each lumen of the
CVC.
*
*
*
*
*
*
MALPOSITION
*
*
*
*
*
*
THROMBOSIS
*
*
*
difficulty with aspiration or
infusion
discomfort in neck or arm
edema of neck or
shoulder
longer external length
ear “gurgling” sound
described during infusion
arrhythmias (if in right
atrium)
*
*
*
upper chest pain, jaw
pain, ear ache
swelling of arm, neck and
shoulder on same side a
catheter
sluggish flow of IV
solution
*
*
do not use catheter
inform physician/NP
CXR
*
*
*
do not use catheter
notify physician/NP
Page
19 of 21
*
*
*
Never use force when
flushing.
Unclamp before
flushing.
Keep catheter
securely taped.
Vary position of
clamps along lumen.
Perform hand hygiene
& wear clean gloves
before handling
catheter or
equipment.
Maximum barrier
precautions at
insertion
Strict aseptic
technique.
Change dressings
and equipment
according to
procedure and prn;
i.e. soiled, loose,
damp.
Minimize accessing
catheter.
Remove catheter
when therapy
complete
Ensure catheter and
tubing secured.
Monitor catheter
insertion length with
dressing changes,
each shift and prn.
Ensure PICC not
accidentally
withdrawn during
dressing changes.
NEVER push PICC
back into vein.
Monitor for signs and
symptoms and report.
Avoid trauma or
movement of
catheter.
Obtain order for
Venous Doppler to
rule out DVT
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
COMPLICATION
SIGNS & SYMPTOMS
ACTION
PREVENTION
SUPERIOR
VENA CAVA
SYNDROME
*
*
*
Catheter
Embolism
progressive shortness of
breath, dyspnea, cough,
chest skin tightness;
unilateral edema,
cyanosis of face, neck,
shoulders and arms;
jugular, temporal and arm
vein distension
As for air emboli.
Observe for ruptured / damaged
/broken catheter.
*
*
*
notify physician/NP
immediately at first signs
and symptoms
place in semi-Fowlers
position and start oxygen at
2 L/min.
provide emotional support
monitor cardiovascular and
neurologic status
Notify physician/NP.
Page
20 of 21
Monitor for signs and
symptoms.
Cause is due to
flushing against
resistance, or excess
stretching of catheter
with
movement/ambulation
Care and Removal of Peripherally Inserted Central
Catheters (PICC) for Adults
Date Effective
July 11, 2014
Policy No.
VII-B-305
Page
21 of 21
Appendix A
PICC DRESSING CHANGE PRINCIPLES
A clean and dry dressing at the insertion site is important to protect the site and to minimize the risk of
infection.
Know the external length of catheter at the time of insertion, so that you can determine if the catheter has
been accidentally malpositioned during the dressing change. Each black dot indicates 1 cm. If malposition is
suspected, obtain order for chest x-ray. SecurAcath is 3 cm long. NEVER push PICC back into insertion site
Change dressing if damp, loosened, or soiled and at scheduled times.
Wear clean gloves:
• to remove transparent film dressings;
• to remove PICC from StatLock™
• to remove the StatLock™ device from the skin
Hand hygiene then don sterile gloves
Wear sterile gloves
• prior to touching any part of the newly cleansed catheter or skin, and for replacing a new sterile
StatLock™ device
Wear Clean or sterile gloves
• to clean skin and external catheter that will be under the new dressing
Wear a mask to prevent site contamination with mouth bacteria
Cleanse by using a back and forth, and up and down motion with gentle friction for at least 30 seconds.
Chlorhexidine products requires an application time of at least of 30 seconds with friction to be effective
Let cleansers dry: Allow all cleansers and barrier films to thoroughly air dry. No fanning, blowing, or drying
with gauze. It must air dry completely (1-6 minutes) prior to applying any other product. Applying barrier film or
adhesives when the antiseptic solution is still wet will result in skin irritation.
Loosely apply transparent dressing over the insertion site and catheter then apply pressure at the insertion
site and over the catheter to establish adhesion to the skin and catheter. Note: Do not stretch the transparent
film while applying the dressing because this may cause skin stripping and/or blister formation at the dressing
edges.
Do not use scissors to remove tape or dressings as the catheter may be accidentally cut.
Use an assistant for confused and uncooperative patients who may accidentally remove their catheter. The
risk and cost of replacing the catheter outweighs the cost of using two staff members.
Performance Criteria StatLock™ PICC Dressing
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Met
Not
Met
Performs hand hygiene and collects materials
Performs hand hygiene prior to entering patient/resident room
Identifies self to patient/resident
Confirms patient/resident ID with 2 identifiers (has patient/
resident actively involved in identification if possible)
Explains procedure to patient/resident
Dons mask. Perform hand hygiene & dons clean gloves. Cleans work area with low level
disinfectant and allow to air dry. Removes gloves. Performs hand hygiene.
Opens packages onto sterile tray keeping all supplies sterile. OK to open and arrange packages
on edge of sterile field.
Dons clean gloves
Removes old dressing ensuring PICC line stabilized
Using a chlorhexidine and alcohol swabstick, removes the StatLock ™. Suture wing may be held
to ensure PICC is not accidentally removed. Extension taped so that PICC does not accidentally
migrate out, but allows for cleansing of skin and external catheter.
Either clean or sterile gloves may be used to clean skin and external catheter. If sterile gloves
chosen, remove clean gloves, perform hand hygiene and don sterile gloves.
Cleanses skin that will be covered by the dressing in a back and forth motion using friction. Then
cleanses using the other side of swabstick using an up and down motion with friction.
Chlorhexidine requires contact for at least 30 seconds to be effective.
Using a new swabstick cleanses along external catheter from insertion site up to and including
suture wing. Using the other side of the swabstick, cleanses along the underside of the external
catheter and suture wing.
If sterile gloves worn and catheter needs to be moved gloves may be protected with sterile
gauze. Caution: if gauze becomes wet considers gloves contaminated.
Allows chlorhexidine/alcohol to dry completely (1-6 minutes)
Applies barrier wipe staying 1cm away from insertion site (not to be used on broken skin or
under chlorhexidine dressing /patches )
Counts all markings (one dot equals 1 cm – compare with original length, if discrepancy exists xray placement verification prior to use)
Sterile gloves required. Places PICC in stabilizing device and positions prior to removing tape
backing. Adhere stabilizing device to skin.
Replaces Steri-Strips™ if required only on catheter suture wing.
Loosely applies transparent dressing covering insertion site, securement device and all exposed
catheter including suture wing. Extension does not need covering.
Label: date and initial
Removes gloves and performs hand hygiene
Trouble-shoots common problems effectively
Provides patient teaching
Tidies work area
Performs hand hygiene prior to leaving patient/resident room
Documents procedure and patient/resident teaching outcomes
Date
Staff Member
Observed By/Designation
Print name
Print name
Signature
Signature
Comments ___________________________________________________________________
PICC Dressing & Q96H Cap Change Performance Checklists
Page 1 of 3
Performance Criteria SecurAcath™ PICC Dressing
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Met
Not
Met
Performs hand hygiene and collects materials
Performs hand hygiene prior to entering patient/resident room
Identifies self to patient/resident
Confirms patient/resident ID with 2 identifiers (has patient/resident actively involved in
identification if possible)
Explains procedure to patient/resident
Dons mask. Perform hand hygiene & dons clean gloves. Cleans work area with low level
disinfectant and allow to air dry. Removes gloves. Performs hand hygiene.
Opens packages onto sterile tray keeping all supplies sterile. OK to open and arrange
packages on edge of sterile field.
Dons clean gloves
Removes old dressing ensuring PICC line stabilized
Either clean or sterile gloves may be used to clean skin and external catheter. If sterile
gloves chosen, remove clean gloves, perform hand hygiene and don sterile gloves. .
Using chlorhexidine cleanses skin that will be covered by the dressing in a back and forth
motion using friction. Then cleanses using the other side of swabstick using an up and
down motion with friction. Chlorhexidine requires contact for at least 30 seconds to be
effective.
Using a new swabstick cleanses along external catheter, soaks SecurAcath, then from
insertion site up to and including suture wing. Using the other side of the swabstick,
cleanses the underside of the external catheter, SecurAcath and suture wing.
If sterile gloves worn and catheter needs to be moved gloves may be protected with sterile
gauze. Caution: if gauze becomes wet considers gloves contaminated.
Allows chlorhexidine/alcohol to dry completely (1-6 minutes)
Applies barrier wipe staying 1cm away from insertion site (not to be used on broken skin or
under chlorhexidine dressing /patches )
Counts all markings (one dot equals 1 cm – compare with original length, if discrepancy
exists x-ray placement verification prior to use)
Replaces Steri-Strips™ if required only on catheter suture wing.
Loosely applies transparent dressing covering insertion site, securement device and all
exposed catheter including suture wing. Extension does not need covering.
Label: date and initial
Removes gloves and performs hand hygiene
Trouble-shoots common problems effectively
Provides patient teaching
Tidies work area
Performs hand hygiene prior to leaving patient/resident room
Documents procedure and patient/resident teaching outcomes
Date
Staff Member
Observed By/Designation
Print name
Print name
Signature
Signature
Comments ___________________________________________________________________
PICC Dressing & Q96H Cap Change Performance Checklists
Page 2 of 3
Met
Performance Criteria Every 96 hours Injection Cap change
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Performs hand hygiene and collects materials
Performs hand hygiene prior to entering patient/resident room
Identifies self to patient/resident
Confirms patient/resident ID with 2 identifiers (has patient/
resident actively involved in identification if possible)
Explains procedure to patient/resident
Cleans work area with low level disinfectant and allow to air dry
Performs hand hygiene and dons clean gloves
Cleans around the cap/hub junction for 15 seconds with wipe containing alcohol or
chlorhexidine with alcohol and allows to dry
Closes clamp if applicable
Using no touch technique removes cap and replaces with sterile cap.
Scrubs hub of cap with antiseptic wipe then flushes with normal saline. Scrubs hub again
and locks PICC with ordered locking solution. Note: if normal saline is the locking solution,
the second injection is not required.
Removes gloves and performs hand hygiene
Trouble-shoots common problems effectively
Provides patient teaching
Tidies work area
Performs hand hygiene prior to leaving patient/resident room
Documents procedure and patient/resident teaching outcomes
Date
Staff Member
Observed By/Designation
Print name
Print name
Signature
Signature
Comments
PICC Dressing & Q96H Cap Change Performance Checklists
Page 3 of 3
Not
Met
PICC Removal Demonstration Checklist
Removing PICC
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Demonstrated
Correctly
Yes
No
Ensures patient care order for PICC removal. Ensures all IV
medications/solutions have been discontinued, or alternate IV site
established.
Perform hand hygiene. Assemble equipment. Don mask. Don clean
gloves and use hospital disinfectant to clean over-bed table or
procedure table prior to opening sterile supplies. Remove gloves.
Perform hand hygiene.
Identifies and teaches patient. Positions patient. Position patient arm
abducted at a 45-90° angle and the exit site below the level of the
heart.
Performs hand hygiene. Using aseptic technique opens sterile
equipment. Dons clean gloves.
Removes dressing. Inspects site. If purulent drainage is noted, is
prepared to obtain swab and 5 cm catheter for C&S.
Removes StatLock™ device if applicable. Remove top part of
SecurAcath. Note: Remainder of SecurAcath removed after PICC
removed. Cleanses skin over insertion site.
Beginning at exit site, and using gentle, even pressure slowly
removes PICC. If resistance encountered, pauses procedure to allow
vein to relax. If firm resistance is encountered, stops procedure and
covers PICC with new sterile dressing and performs steps to reduce
Venospasm (12.7).
Once PICC removed, applies digital pressure until homeostasis is
confirmed. If applicable removes SecurAcath at this time as per
manufacturer’s instructions (see video). If applicable, obtains tip for
culture as per procedure (12.7.14).
Applies air occlusive dressing: Uses petroleum gauze, sterile gauze
and transparent film; or sterile gauze and hydrocolloid dressing to
site.
Inspects PICC for length and integrity. Disposes of PICC.
Trouble-shoots common problems effectively.
Provides patient teaching.
Tidies work area.
Performs hand hygiene prior to leaving patient/resident room.
Documents procedure and patient/resident teaching outcomes.
☺________May perform skill independently
__________Please repeat
Observer Signature
__________________________________________________
May 2016