PICC line dressing change: am I in trouble?

[Wheretogo]

Hi all, I'm new to this site, so please bear with me. I thought I'd ask for some advice or opinions on a situation I encountered involving a PICC dressing change. I'm a fairly new grad working in home health care. It's been tough, but I look up policies and do research often to get through my days. I was also an excellent student so feel I can make it in home health with extra effort at the start. That doesn't come without worrying though, and I've been questioning my abilities as a nurse lately...I had a patient who needed a PICC dressing change. I've done a few awhile back, so felt okay going through with this on my own. However, the only tegaderm available was the smallest size, so when covering the catheter site, I was able to do it with the waterproof dressing, but it wasn't large enough to cover the statlock securement device. So for this, I used sterile gauze and paper tape roll. I mentioned in my documentation that there were no large waterproof dressings available, but am worrying about this. My manager frowned and but didn't seem worried and didn't give me much advice when I told her this after the fact. I'm normally very conscientious and should have sought help right away, but I guess recent fatigue didn't allow to be on my A-game. I'm stressed that the statlock isn't covered with a waterproof barrier, but guaze and tape, and am really kicking myself. Ay, ay, ay. Any thoughts?

[afraser]

Hey, don't beat yourself up. You thought on your feet in the situation at hand, and came up with a solution. We learn as we go, nobody is perfect, and nobody knows everything. New grads have challenges no matter what area they begin their career in, as do more seasoned nurses. Onward and upward! I'm sure you're taking great care of your patients as you seem very caring and compassionate!

[Susan317]

I'm wondering if you should have changed it all ,doesn't the IV company typically change the dressing. Your job is only to assess the site and inform the IV company of any changes. Unless of course your agency is also a home infusion company?

[KelRN215, BSN, RN]

I'm wondering if you should have changed it all ,doesn't the IV company typically change the dressing. Your job is only to assess the site and inform the IV company of any changes. Unless of course your agency is also a home infusion company?

In my area, the IV/infusion companies deliver supplies and do basic teaching in the hospital. They do not change dressings/caps, perform infusions, teach in the home or anything of the sort. My company is nursing only and I do all CVL dressing changes and cap changes on all my patients.

[paradiseboundRN]

Don't beat yourself up. If you are worried about, go back ASAP and change it. I've been in home care for 11 years and still have problems at times. Remember you are not in an ideal environment where the supplies are down the hall. Keep a good stash in the car. You'll become a hoarder like the rest of us. Btw, they hire new grads because there is a shortage of hh nurses, at least in my area, and no hospital jobs.

[cathrn64]

I'm wondering if you should have changed it all ,doesn't the IV company typically change the dressing. Your job is only to assess the site and inform the IV company of any changes. Unless of course your agency is also a home infusion company?

Susan317,

I have never worked for any company where the IV company did anything other than drop off supplies. They have pharmacist's who do manage the dosing etc, but not anything in the home!

OP, I have run into this situation and the main thing is to make sure the insertion site is covered and secure. I have worked in home care long enough that there were no securement devices. I have always used transparent tape or steri strips (which come in the sterile kit) to secure the PICC if there is no device

[SuesquatchRN, BSN, RN]

I think you are fine, but never ever ever document that there was a lack of anything and that you were therefore required to do something in a less-than-exemplary manner. It's begging the surveyors (those who oversee your agency) to cite you for a deficiency. That was the reason for the frown, not that you made do.

"Dressing changed using sterile technique. Clear occlusive dressing and sterile gauze used to cover." That's it. No discussion about what was NOT available.

And good luck. You'll be fine.

[SuesquatchRN, BSN, RN]

Hey, this is old. Never mind.

[Krystal215]

You did a great job with what you had. I was a new grad when I started out in HH. I have been at it for 2 years and I am always learning new things. You were thinking critically and you did the best with what you had. Don't forget that your supervisor should always be available to help you, don't hesitate to ask others for help or advise. I keep extra supplies in my car because I never know what I will need.