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WHAT IS A
STERILE PHLEBITIS?
Simply stated it
is an irritated vein. The inner wall of the vein was traumatized upon
catheter insertion and is irritated and inflamed in response. This
irritation can lead to loss of the catheter. If assessed and treated
promptly, the irritation will subside and no further complications will
develop. A phlebitis that develops after one week of placement can not be
considered sterile/mechanical without further investigation.
ASSESSMENT
·
Observe daily the insertion site and the
upper arm when the patient has a PICC line.
·
Anticipate this potential problem and be
prepared to treat to preserve this line.
CHARACTERISTICS
·
Symptoms must have occurred
within first week of PICC placement.
·
Redness in upper arm.
·
Redness follows vein path.
·
Tenderness from insertion along vein
path, especially upon palpation.
·
Swelling which looks like infiltration
will develop as the inflammation progresses.
·
If progressed, may appear like
cellulitis.
·
Patient may complain of pain or
tightness in upper arm.
·
No drainage of any kind will be present.
TREATMENT
Treat only if
catheter is less than one week old.
·
Initiate continuous, warm, wet
compresses to the red/tender area of upper arm.
·
Elevate limb.
·
Treat for two days and re-evaluate.
·
Continue to use the catheter while treating.
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WHO SHOULD BE
NOTIFIED?
·
Notify the Vascular Access Nurse as soon
as the phlebitis in discovered.
·
Notify the physician after two days of
treatment if the redness and swelling does not improve.
·
If patient develops fever and/or
purulent drainage and/or the site appears worse after two days of treatment,
notify the Vascular Access Nurse and the physician immediately.
DID YOU
KNOW?
PICC lines are a
wonderful way to reduce cost, patient discomfort and nursing time. It is
very important to take extra steps to make sure that this line is cared for
and protected. They often are the last resort before initiating a central
line or a surgically placed line. Here are some important tips for caring
for a PICC:
Ø
Always keep the hub of the
catheter secured under the dressing to prevent pulling on the catheter.
If the hub is loose, migration of the catheter is probable.
Ø
Always use the smallest lumen
of a dual-lumen PICC for continuous infusions. Save the large one for
blood draws. (Lumen size is imprinted on the catheter’s pigtails.)
Ø
If one lumen is not being
used it must be flushed and heparinized daily and after each intermittent
use.
Ø
Remember: dual-lumen
catheters are like two catheters wrapped into one line. Their paths do not
meet, so they must be cared for independently.
Ø
Just because we got
one PICC in place does not mean that another one will be possible. So,
cherish the one you have.
DOCUMENTATION
·
Be sure to observe and document arm
circumference, external catheter length and condition of site each shift.
·
If sterile phlebitis, or any problem
develops, document the treatment, arm circumference and site condition each
day until compresses are discontinued.
·
Be sure to note who you notify of the
problem and treatment in your notes.
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