SUBJECT: Central Venous Catheter, Tunneled, Dressing Change



UNIVERSITY OF IOWA COMMUNITY HOMECARE

SUBJECT: PICC Dressing Change

PURPOSE: To minimize the potential for local or systemic catheter related sepsis in patients with tunneled central venous catheters.

DEFINITIONS:

a) PICC – a Peripherally Inserted Central Catheter is a non-tunneled intravenous catheter. The catheter may be placed at the bedside by trained personnel. For the catheter to be considered central, the tip must be in the SVC. Central catheter tip location shall be determined radiographically and documented prior to initiation of IV therapy. These catheters may be left in for an indefinite period if there are no signs of complications.

b) MLC – Mid-Line Catheter is a non-tunneled intravenous catheter inserted by trained personnel. The catheter may be placed at the bedside by trained personnel. The tip of the catheter may be at any point between the insertion site and the clavicle. Tip placement does not have to be confirmed by x-ray. These catheters are used for short term therapies.

POLICY:

1. Change gauze dressings every 48 hours.

2. Change transparent dressing and securement device every 7 days.

3. Change catheter-site dressing whenever the dressing becomes damp, loosened, or visibly soiled.

4. For neonatal/pediatric patients, non-sutured line dressing changes occur prn.

PROCEDURE:

EQUIPMENT:

Gloves

Sterile gloves

Chloraprep applicator

Sterile 2x2

Transparent dressing (10 cm x 12 cm)

Skin protective agent

Tape

Alcohol

Securement device

Valves

Extensions

Adhesive tape remover

Normal Saline flush

Heparin flush

1. Explain procedure to patient.

2. Assemble equipment.

3. Clean table and work area with alcohol.

4. Wash hands thoroughly.

5. Put on gloves and carefully remove existing dressing and securement device. Pull the dressing toward the exit site to avoid tension on the catheter. Observe exit site for redness, purulent or serosanguinous drainage, swelling, leakage of solution or kinks in catheter.

6. If needed, use adhesive tape remover, not closer than one inch from the exit site, to remove tape residue.

7. Remove gloves and wash hands and don sterile gloves

8. Cleanse exit site with Chloraprep applicator using mechanical friction in a side-to-side motion for 30 seconds. Make sure to clean under catheter and around exit site. If it is a pediatric patient avoid cleansing over the exit site.

9. Allow Chloraprep to dry for 30 seconds.

10. Swab periphery of dressing site with skin protective agent. Allow to dry.

11. Apply securement device if used.

12. Apply transparent dressing over the exit site.

13. Remove old extension tubing and valves and apply new ones. Check line patency by aspirating for blood. (If no blood return is noted assess need for Cathflo.) Flush with 10cc of Normal Saline, then heplock if needed when not starting an infusion. Apply a swap to valve (s).

14. Discard all disposable equipment.

15. Remove gloves and wash hands.

16. Document dressing change. Documentation should reflect the condition of the catheter and access site, patient’s response, and specific nursing actions taken to resolve or prevent adverse reactions and should be recorded in the patient’s permanent medical record.

PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS:

1. To remove any crust or drainage at the exit site, use a sterile applicator soaked with normal saline.

2. In the event the catheter becomes severed or is damaged, immediately clamp between the damaged catheter and patient. Cover the end with sterile gauze. Immediately notify physician.

3. If the patient is allergic to Chlorhexidine (Chloraprep), PVP swabs should be used to cleanse insertion site. Use mechanical friction in a side-to-side application for one minute. Repeat with the other two swabs. Allow PVP to dry for 2 minutes.

4. If the patient is allergic to transparent dressing, use sensitive skin dressing (e.g. Primapore or gauze and tape).

REFERENCES:

Baranowski, L. (1993). Central venous access devices. Journal of Intravenous Nursing, 16(3), 167-194.

Rostad, M. (1992). Intravenous access devices: Part III. Urologic Nursing, 12(4), 130-135.

Intravenous Nursing Standards of Practice, 2011.

Freiburger, D., et al. The Effects of Different Central Venous Line Dressing Changes on Bacterial Growth in the Pediatric Oncology Population. Journal of Pediatric Oncology Nursing Volume 9, No. I (January), 1992, pp 3-7.

Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR 2002;51 (No. RR-10):1-29. (May be accessed at )

Written: 1/97

Reviewed: 5/01, 1/03, 5/04

Revised: 1/03, 4/06, 01/07, 2/10, 6/12, 8/12, 6/13, 9/15

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