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PICC Line Dressing Procedure

The routine care and maintenance of a PICC involves weekly flushing and dressing. Security devices such as statlock/griplock requires changing once a week (as per manufacturers’ guidelines).

When performing both the dressing and flushing as one procedure, it is considered best practice to flush the catheter prior to re-dressing the exit site. This aims to prevent the contamination of the hub by skin bacteria which could lead to a systemic infection.

The first dressing should be performed within 24-72hrs of placement. PICC care and maintenance can be performed using aseptic technique or using aseptic non touch technique (ANTT).

Equipment

  • Tray or clean surface
  • Apron
  • Sterile dressing pack or sterile dressing towels
  • Sterile gloves
  • Sterile transparent dressing such as Tegaderm
  • Statlock/griplock
  • Cleaning solution (such as chlorhexidine) in a single-use small applicator (Chloraprep)
  • A special patch called a Biopatch used if high risk of infection or as per referring unit advice
  • Clinell wipes
  • Steri-strips (optional)
  • Single use tape measure

If you have been prescribed a dressing change kit, follow the instructions for using the supplies in your kit.

Technique

  • Social handwash with liquid soap.
  • Collect the equipment needed and clean the assigned surface with a detergent wipe and dry with a paper towel or allow to dry naturally. Wipe the surface again with a sanicloth wipe and allow to dry.
  • Perform a 6 stage handwash with liquid soap.
  • Open the sterile towel and unfold touching the edges only and place on the surface to create an aseptic field.
  • Open the sterile gloves and place on the surface.
  • Open the transparent dressing, Biopatch and chlorhexidine applicator, statlock/Griplock and tip them on the aseptic/sterile field.
  • Open the second dressing towel and place on the client’s arm.
  • Apply alcohol gel to hands and allow to dry before then put on gloves (non-Sterile).
  • Gently peel off the old dressing and Biopatch avoid moving the line. If statlock is used, unclip the PICC line from the statlock and remove it by using alcohol wipe to wipe under the statlock. Do not pull or touch the catheter where it comes out of the arm. Do not pull the PICC as you do this step.
  • Measure the PICC line.
  • Steri-strips can be used to secure the PICC before applying the new dressing to avoid movement.
  • Throw away the old dressing and gloves.
  • Wash your hands and put on the sterile gloves.
  • Check the skin for redness, swelling, bleeding, or any other drainage around the catheter.
  • Use one wipe to clean the catheter.
  • Use another wipe to clean the catheter, slowly working away from where it comes out of your arm.
  • Clean the skin around the site with the sponge and cleaning solution for 30 seconds.
  • Let the area air dry (please do not blow to dry).
  • Place the new Biopatch over the area where the catheter enters the skin. Keep the grid side up and the white side touching the skin.
  • If you have been told to do so, apply a skin prep where the edges of the dressing will be.
  • Apply the new statlock to the PICC line and secure this on the skin without pulling the line.
  • Peel the backing from the clear plastic dressing (for example, Tegaderm) and place the dressing over the catheter ensuring that the exit site is completely covered.

Troubleshooting

Unable to flush the PICC.

Possible causes:

  • Blood clot within the catheter lumen.
  • Mechanical obstruction.
  • Drug or mineral precipitate.
  • Lipid residue.
  • Blocked needle-free connector.

The following actions should be taken:

  • Ensure that the arm is straight.
  • Observe for any external kinks – the dressing may need to be renewed to aid close observation, attempt to flush without exerting force.
  • If the PICC remains blocked contact experienced practitioner for same day referral.

Leaking of fluid at the exit site or along the PICC.

  • Possible tear in the PICC. If tear/fracture is observed, please clamp the PICC line above and below the fracture.
  • Do not remove the dressing – refer to experienced practitioner in the hospital/attend A&E.

The PICC looks shorter or longer.

  • Possible migration.
  • The following action should be taken:
    • Measure the external length of the PICC.
    • Compare with the initial insertion length which will be recorded in the discharge letter.
    • If there is discrepancy, contact the relevant hospital for advice and leave the dressing intact.

The patient is experiencing any of the following symptoms:

  • Pain in the arm shoulder, neck or chest.
  • Redness, swelling, exudate or pain at the exit site.
  • Swelling of the hand, arm, neck, or shoulder.
  • Redness tracking up the arm.
  • Pyrexia or rigor post PICC flush.
  • Referral to the Hospital responsible for the patient’s care should be made whenever any of the symptoms above are present.

 

 

Revised:  January 2024

Version: 2 (Review)

Source:  Expert Care Manager