Questions about PICCs

“VENIFACTS” NEWSLETTER

                                                                                 October 25, 2001

QUESTIONS ABOUT PICCS 

The following VeniFacts will try to answer some of the most frequently asked questions about PICC lines and their care. There are new care and flush standards that everyone will have to learn. So, don’t be afraid to inquire about the care of PICC lines from the PICC nurse.

 WHAT IS THE REQUIRED PROTOCOL FOR DRESSING CHANGES?

The dressing on all central lines, according to the new policy, will be weekly and PRN. However, the PICC dressing should be changed 24 hours after placement, and then weekly. The information for the dressing change is posted on the sign hung in the patient’s room. If there is bloody gauze under the dressing, please change it. If the site is less than 24 hours old replace the gauze to apply pressure on the site. After 24 hours the gauze should be removed and only the Tegaderm (no gauze) should be applied. Be sure the date is noted on the dressing or policy compliance will be impossible. If no dateis noted, change the dressing and be sure to date it.

WHO DOES THE PICC DRESSING?

Any nurse trained in changing central line dressings should change the PICC dressing as well. That includes the 24hour dressing. It is no longer up to the PICC nurse to change the first dressing on the PICC lines.

HOW OFTEN DO I FLUSH THE PICC LINE?

An unused PICC should be flushed q12 hours with 10ml preservative-free NSS followed by 5ml of 10unit Heparin Flush. This is the new central line flush policy. If there is no solution running through a PICC there must be Heparin in it or it will clot. The lumens are fairly small and blood can back up into the lines easily. If you disconnect an IV fluid or piggyback, you pulled blood into the catheter. The PICC must be flushed with non-bacteriostatic NSS and heparin flush or it will clot. Make it a habit to flush the lines even when the patient is disconnected for short periods. Clotting can occur quickly and it may result in added work, expense, and perhaps another venipuncture.

The only line you flush with 100unit Heparin is a port that you de-access (remove the

Huber) for discharge. 100unit Heparin is used when a patient will go an extended period without having their port flushed.

WHAT DO I DO IF PART OF THE PICC IS HANGING OUT?

Catheter migration is possible since only a PICC placed by radiology is sutured. If you find part of the catheter migrated out, secure it well and call the PICC nurse. You can secure it best by removing the dressing, coiling the catheter carefully as not to kink it, and placing it under a clean dressing. Be sure the hub is well secured. This will prevent further migration. NEVER RETHREAD THE CATHETER.

Xray for tip placement to ensure it is appropriate for the therapy the patient is receiving. Ask the PICC nurse to assess the line for tip placement. Once the external catheter is pulled out the tip of the catheter is no longer where it is suppose to be. Look at the sign on the wall. It will tell you where the tip was and how long the external catheter was. Then, when you call the PICC nurse you can discuss tip position with her. If the solution is NOT TPN, you can continue to use the line as long as you still have a blood return. If a catheter migrates, be sure to adjust the measurements listed on the sign posted in the room so others have current measurements to follow.

HOW DOES CATHETER MIGRATION HAPPEN?

The catheter can easily slide out when the dressing becomes loose. Keeping the dressing very secure also secures the catheter. Using benzoin on the skin and steristrips on the hub of the catheter is the best way to secure the catheter in position. NEVER place tape or steristrips directly on the catheter as this could cause cuts in the catheter.