I am learning a lot about picc lines, but have some questions.
1) When doing dressing changes, is it ok to take old dressing off with clean gloves as long as not touching insertion site?
2) When using statlocks, do you use steri strips also?
3) Do you need to wear sterile gloves to change extension and cap?
4) What do you do for a patient with peeling skin under transparent dressing?
5) regarding removal, do you pull out picc in one steady fashion while pt holds their breath or do it inch by inch? I have read both were correct.
Ok all good questions.....
1. Yes!!!!! use clean gloves to remove the old dressing. I t would be pointless to use sterile gloves b/c the minute you touch anything that is NOT sterile the gloves are no longer sterile either. Remember to perform hand hygiene prior to starting the procedure. I put a mask on change the caps and then remove the dressing bc. if you remove the dressing and securement devices and then change the caps it is much easier to pull out a few cms. If I have any infusions going I also temporarily tape the tails to the upper arm so the weight of the IV tubing(s) does not pull any of the PICC out....it is really important NOT to pull the PICC out.....even a couple of cms matters
2. Yes It is OK to use a stat loc or any other securement device and the use steri strips.....sometimes you will not need steri strips...if there are O cms externally visible for example. We tend to leave anywhere from 5-8 cm externally visible so we do use them b/c if there is moisture under the TSM dressing a PICC can still get pulled out under the dressing. The stat nloc needs to be changed at least every 7 days....horrible skin irritation and infection can occur if this is not done.
3. You do have to change the caps and extension sets if you use them in an aseptic manner but you do not generally have to wear sterile gloves to do so. So the connection from your flush syringe to your sterile new cap will be sterile and then the connection form the sterile end of the cap to the extension tubing. Again.... some policies out there require the nurse to wear a mask for cap and ext set changes
4. Try to determine the reason the pts skin may be peeling...you ma need to change the dressing more frequently and use a skin protectant OR use a different type of TSM dressing..IF any gauze is placed under a TSM dressing such as tegaderm it is essentially a 48 hr dressing.
5 Best to pull the PICC out using a hand over hand technique especially the silicone piccs so you do not snap it..the polyurethane piccs are much stronger ...
Last edit by iluvivt on Jan 7, '10