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!

[imanedrn]

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

Yeah. I usually just take the ports (including the one with the fluids infusing) to the pt's skin, so that they start in a straight line, so I can put the dressing on more easily -- that is to say, around the ports. When they're flopping all over the place, it's much harder to get the dressing on -- fluids or not.

[garciadiego]

I wanted to add a question regarding the PICC dressing changes, and if someone has addressed my question in this thread I apologize, I missed it.

I have a BIG problem keeping the procedure sterile and this is why. I use clean gloves to take the opsite, or whatever that transparent dressing is called. Its a pain in the butt to get it off the statlock without contaminating the site but I am able to struggle thru it. After I have most of the dressing removed, it is still in place at the PICC insertion site, and the statlock is exposed, I disengage the stat lock wings from those little plastic pins. Now the question is how do you get the stat lock off and the dressing off without out securing the PICC line with your gloves, which are clean, so that the PICC does not come out when you remove the statlock and dressing? If you hold the line down to secure it it is no longer sterile. Do you put on sterile gloves to secure the line and then remove the dressing and statlock?

And once you have the dressing and stat lock off, you put on sterile gloves and clean with cloroprep...the question here is are you allowed to lift the line up to clean under neath the line? I think so if you lift by the PICC site, as this are is sterile, the skin at this site should be sterile and you have sterile gloves on.

I know this all sounds tremendously complicated but it is not an easy procedure and I have spoken to other nurses and they have problems, and no answers, also.

Mahalo

[iluvivt, BSN, RN]

When you get to that point..have a 2x2 or several ready and open and just set them over the insertion site or portion of the PICC externally visible. It is very important that you do not pull out any of the PICC...even if it only one cm. What happens is that if a cm or two is pulled out with every dressing change...after several dressing changes you will eventually pull the PICC out of the SVC. The average adult has a 2.5-3 inch long SVC. So you only have appprox7-10 cm that you can pull out before you have malpositioned the PICC. You will have less if PICC is in upper SVC or mid SVC

[JBizzleRN, ADN, RN]

Really? Every 7 days? Our hospital is still on the every 96 (every 4 days) protocool.

[iluvivt, BSN, RN]

There has been a ton of research done on the optimal time frame for dressing change frequency as well as type of dressing. There is still research ongoing. There is agreement and recommendations for the following. Any dressing with gauze under the dressing should only be kept on for 48 hours. Bacteria counts rise after this time frame when gauze is under the dressing. A TSM (transparent semi-permeable membrane dressing) can be left in place for 7 days as long as it is clean dry and intact. The CDC does not go as far as recommending an impregnated chlorhexadine disc ( as in a Biopatch) or a chlorhexadine patch (as in tegederm CHG) ,but in it 2002 document states the research thus far is promising. keep in mind that was 2002 and a lot more research has been done. The CHG at site products will release the CHG for 7 days. Some hospitals change more freequently,but the research shows a q 7 day dressing is within the standard of care......just remember that this is with the TSM dressing only....no gauze under the TSM. It is OK to pad the catheter tails if needed. The only exception to this is with ports when at times you have to pad the non-coring needles stable.

[garciadiego]

Iluvivt

Your solution is so simple and obvious that I'm embarrassed that it has been a problem for me.....although none of the nurses where I work offered a solution.

Mahalo

[rnrubyblu]

I realize this is an old thread but I am a new nurse and I have only done one before today. Today I was nervous. I don't remember seeing a stat lock on the picc lines before but of course this one had it. I decided that it couldn't be really cleaned unless I removed one so I did. I cleaned the site and put the dressing on, but no stat lock in the kit to put a 'clean' one back on. So no stat lock. Of course, not until I was home, did I remember that I did not put the biopatch on. I immediately called the unit and the next shift says they will change the dressing if they have time. I soo hope that they do. I am freaking out. I did try my best and it was only my second cvad dressing change. Do you need a stat lock everytime?

[IVRUS, BSN, RN]

I realize this is an old thread but I am a new nurse and I have only done one before today. Today I was nervous. I don't remember seeing a stat lock on the picc lines before but of course this one had it. I decided that it couldn't be really cleaned unless I removed one so I did. I cleaned the site and put the dressing on, but no stat lock in the kit to put a 'clean' one back on. So no stat lock. Of course, not until I was home, did I remember that I did not put the biopatch on. I immediately called the unit and the next shift says they will change the dressing if they have time. I soo hope that they do. I am freaking out. I did try my best and it was only my second cvad dressing change. Do you need a stat lock everytime?

A stat lock is a catheter securement device. Suturing isn't done much anymore. So, should another Statlock or another catheter securement device be replaced with each dressing change? Yes. And that is why you need to take one with you, as it is not usually in the central line dressing change kit. These devices keep the IV catheter secured to the skin and help prevent catheter movement or migration in or out.

Let's just pray that the next shift was able to replace the dressing properly, howvever, Since you did not have one to replace the old one with, I'm sure you secured the catheter with tape and a transparent dressing. Don't stress.