Changing PICC Dressings

[imanedrn]

Any advice?

I haven't changed many PICC dressings. Until yesterday, I've always had help. The one I did yesterday, though, I didn't do too well. The dressing & line were intact when I was finished, but it just didn't look "neat."

My problem is that the dressing always sticks mercilessly to my gloves, then ends up looking messy when I'm finished. What can I do to prevent that?

Also, a lot of people are using stat-locks now to hold the lumens in place. I don't care for them because I think it give less room to wrap the tubing under the dressing. That was the big problem I had with the dressing yesterday. After I removed the initial dressing, when I tried to wrap the tubing between the stat-lock & the insertion point, it seemed like I didn't have enough room. The previous nurses have had no problems, but I obviously did.

I think my biggest issue with the whole thing, though, was dealing with the dressing sticking to my gloves -- so I'd be trying to pull off the dressing & hold the tubing at the same time. As I said, the dressing is intact, it's just not "neat" looking.

I think my big mistake might have been removing the entire backing of the dressing all at one time, instead of slowly (i.e., remove the top, apply dressing, and slowly peel backing away while applying the dressing).

Also, what do you use those 2 extra pieces of tape on the sides for? I've heard several suggestions, such as using them to hold the line in place while applying the dressing -- which I thought about doing but couldn't because they stuck to my gloves also, and I couldn't salvage them!

So... any advice? What do you do to make it work?

TIA!

[iluvivt, BSN, RN]

OK here is my advice. You need to look at as more than just a dressing change. You should use the securement device (stat loc) if you have one. The goal here is to keep the PICC in place with the same amount externally visible btween dresiing changes. You do not want any more length to go in or to come out. The best way to do this is with proper securement. The dressing change is a sterile procedure. So remove everythinh (including the stat loc with unsterile gloves. Prepare your set-up (now or before you remove the dressing). Cleanse with the Chloraprep (I hope ypu are using this) scrub in a back and forth manner for at least 30 sec and allow to completely air dry. We use a skin prep that comes with every stat loc and often use 2-3 per dressing. Then we apply the biopatch (smooth side to skin). If there is a lot externally visible we additionally secure with steri-strips We then apply the TSM (Transparent Semi Permeable Membrane Dressing) >If you are not used to working with these have someone show you. It sounds like you are using the tegaderm with the Hypa-fix type border. You do not need to use the little tape strips if you do not like them...you can cut your own. I hat it when nurses use transpore tape to secure PICCs. it alwaysseems to break open the skin. We like hypa-fix keep practicing

[imanedrn]

I ended up having one Sunday. I left the backing on the dressing & peeled it off while applying it to the skin. Also had the pt's arm more exposed. Seemed to work like a charm :wink2:

[classicdame, MSN, EdD]

The stat-locks are not designed to have tubing under them and it should not be necessary if the stat-lock is applied.

[Jolie, BSN]

iluvivt,

I question removing the Stat-loc with every dressing change. In my experience, the hub of the catheter is so securely anchored in the Stat-loc that removing it would risk dislodging the hub of the PICC line, and the line itself. It is my understanding that the manufacturer intends for the Stat-loc to remain in place as long as the line exists, unless there is a compelling reason to change it. Can you refer me to an article or P&P that supports routinely changing the Stat-loc?

Thanks!

[imanedrn]

iluvivt,

I question removing the Stat-loc with every dressing change. In my experience, the hub of the catheter is so securely anchored in the Stat-loc that removing it would risk dislodging the hub of the PICC line, and the line itself. It is my understanding that the manufacturer intends for the Stat-loc to remain in place as long as the line exists, unless there is a compelling reason to change it. Can you refer me to an article or P&P that supports routinely changing the Stat-loc?

Thanks!

I don't know of an article, but (if I remember the last one I looked at), it says ON the stat-lock that it should be changed w/ each dressing change. Is that sufficient?...

[Jolie, BSN]

I don't know of an article, but (if I remember the last one I looked at), it says ON the stat-lock that it should be changed w/ each dressing change. Is that sufficient?...

I think that the product I've used is a "knock-off" and not the brand name product. I Googled "Stat-lock IV device" and saw pictures of a device that has a release mechanism that grabs and lets-go of the wings on the catheter hub so that the Stat-lock could be changed without putting excessive tension on the catheter or hub.

The device we use does not have such a release. The hub of the catheter snaps into the anchoring device and has to be pulled out of it with some force. That's why I questioned routinely changing the Stat-loc.

Now I'll have to look more closely at the product name on the label :)

[iluvivt, BSN, RN]

Yes you must change the stat loc with every dressing. I have smelled one that has not been not changed and I can tell you it is gross. Bacteria and yeast can grow on it ,around it and under it just like any other dressing material It also comes loose entirely or at least partially when removing the dressing. I can tell you for a fact that it must be changed with every dressing change or you are are taking a short cut that will put your pt at an increased risk for infection. I have been placing PICCs and changing the dressing since 1989 as well as tracking complications. We use maximum barrier precautions to place them but that is only the start of things, It must be used and cared for properly. I will try to refer you to a reference but Like I said I already know this for a fact

[elthia]

http://www.statlock.com/products.html

If you click the instructional poster pdf link to the Right, at the bottom of the poster it states the statlock needs to be changed q7 days.

[iluvivt, BSN, RN]

Yes the stat-loc should be changed Q 7days and that is how often a lot hospitals etc.are changing the PICC dressing unless the pt has a gauze dressing (which is usually the initial dressing). So if you are changing the dressing every 7 days you should change the stat-loc every time. Now if you are going from a 48 hour dressing to a 7 day dressing it could be 9 days before the stat loc gets changed so I change it every time to avoid this problem

[RNsRWe, ASN, RN]

Yes you must change the stat loc with every dressing. I have smelled one that has not been not changed and I can tell you it is gross. Bacteria and yeast can grow on it ,around it and under it just like any other dressing material It also comes loose entirely or at least partially when removing the dressing. I can tell you for a fact that it must be changed with every dressing change or you are are taking a short cut that will put your pt at an increased risk for infection. I have been placing PICCs and changing the dressing since 1989 as well as tracking complications. We use maximum barrier precautions to place them but that is only the start of things, It must be used and cared for properly. I will try to refer you to a reference but Like I said I already know this for a fact

Not only that, but every time I change a PICC dressing, the statlock pretty much is ruined with peeling off the Tegaderm! We have the kits with the 'official' Stat-Loc, and the little wingy-things that clip the line in place are very easy to release. It's the rest of the Stat-Loc itself that sticks to the rest of the dressing, so....off it all goes. Then the whole area of skin can be cleaned and prepped for the new dressing. Nothing old left behind. In school we were taught to use masks as well, to hamper infection, and to either place a mask on the patient or have them turn their faces away while the dressing change was going on. Occasionally I see someone NOT using the masks, and I cringe just a little.

[IngyRN]

Is it ok to change a dressing while pt has running fluids??