[Kayde]

WE received a longterm antibiotic 3 week old with a picc line from a university hospital. My question is are dressing change care the same as adults? Also , who removes the line when finished with antibiotics? Our instructions are to change the dressing once a week. Do you do an alcohol ring followed by betadine ring , let dry and then apply an opsite? My question comes from how tender an infant skin is. This is the first one I have seen. Thank you for any reply.

[Jolie]

I don't have time to look thru my journals right now, but I know that Neonatal Network has published 2 articles in the last 3 or 4 years on the insertion and care of PICC lines in neonates. I'm pretty sure they were both written my Mary Kay Leick of Children's Mercy Hospital in Kansas City, who is an expert on the subject. If you can find them, they will tell you all you need to know about caring for and removing PICC lines. You will definitely need to develop a policy and procedure pertaining to them. The referral hospital which sent you your patient should also be able and willing to help. Good luck!

[NICU_Nurse]

I've got the company booklet for Neo-PICC here, and it doesn't specify what to use when cleaning (it specifically says:

Clean the insertion site with prep solution(s) per policy, starting at the insertion site and working outward, in concentric circles, to an area as big as the transparent dressing. Allow to dry completely. Note: In the neonatal setting, sterile water is sometimes used to remove the prep solution at this point, to prevent direct uptake into the venous system.)

*Source: Cheryl A. Klein, RN, Manager of Clinical Education
Klein-Baker Medical, Inc.
1-800-640-NICU
www.neocare.com or ckleinpicc@aol.com

Maybe you could email her and get one of these little books? It has everything you need to know about this particular brand of PICC lines and has been very helpful to me.

In our facility, we use Betadine first, allowing it to totally dry, and then alchohol or sterile water pads to remove it (don't leave the Betadine on the skin of a neonate, especially under a dressing).

According to the booklet, you use tape to secure the line (these particular lines have "hearts" that are stronger than the catheter itself, and this is what you're taping over; I don't know what brand they used for your baby) and then a transparent dressing. We don't use gauze- this necessitates a change q 48hrs. Don't put tape directly on the catheter- they're very weak and easily torn or dislodged. Don't reinsert the catheter if it has come out of place, call the MD.

A good bet, as mentioned above, would be to call the hospital the baby came from and have them fax over a copy of their policy for PICC changes. I'm sure they'd be willing to do that.

[NicuGal]

Treat it just like a central line...that is what our hospital policy states.

Remember that you shouldn't put tape anywhere on the line itself, only steri-strips and opsite. When you dress it, put the opsite about half way down the heart and then chevron it so that it holds it tight. There should be an insert with the cath that shows how to dress it.

I don't know how your policy reads, but only a doc or NNP can remove our caths incase they snap off.

[NICU_Nurse]

This shows you how to tape it:

http://www.neocare.com/dressing_change_procedure.htm

[NICUNURSE]

On our unit, we have a PICC line team, made up of nurses, who change and repair all PICC lines. These are nurses who work on our unit, but have taken a special PICC line class. That being said, changing the dressing is similar to how you would do an adult, except, as someone else mentioned, we don't leave betadine on the site. We usually clean with two alcohol swabs, then three betadine, let that dry and then clean with the remaining alcohol. The actual line itself is secured to the skin with steri-strips, NEVER tape. Then we cover w/ tegaderm. Our dressings are changed on a PRN basis. As for removal of the PICC, we as RN's are allowed to remove them unless it was a cut down PICC line, in which case either the NNP or MD removes it.

[Kayde]

Thank you for all who replied. Our infant did well and was released. The physician removed the line.

[NICU_Nurse]

Oops...I said "tape" but didn't mean tape. Sorry! Reiterating: only steri-strips.