I'm doing a presentation for the clinical staff at the rehab hospital where I work. I've noticed that some of the nurses are making errors regarding PICC line maintenance and I wanted to fix them. I've found some research articles and some excellent videos online regarding dressing changes, flushing, etc, but I am missing a piece that I feel is vital to my mission... "tips and tricks".
What are some things you've learned from experience (and if possible, an article to provide EBP) regarding the maintenance of PICC lines? There are so many tiny details that can go NOT according to plan, how do you deal with them?
An example...Someone wrapped the tegaderm AROUND the picc line. Wouldn't come undone with alcohol OR adhesive remover. But you aren't supposed to use scissors, so what do you do? What if you nick the line?
I'm sure you've had experiences like this and learned from them, so if you could please share that'd be much appreciated!
Jan 23, '13
PM me with your E mail I have something you will like that you can use for training . It is a teaching guide that I wrote for dressing change procedure,maintenance and troubleshooting. if it is done correctly from the start you alleviates a lot of these problems. It is on my computer at work though so I can not sent it to you until this Sunday when I get there.
It sounds like the dressing came loose so instead of changing it they decided to add to it and needed some skin for the TSM to stick to so had to wrap the tegaderm all the way around. In that case it is nearly impossible to get it loose so I would get a suture removal kit scissor or a bandage scissor and only cut the tegaderem that is on the back of the arm nowhere near the PICC so you do not nick it or damage it. If you have too many layers of the TSM it impairs its function as well. It should NEVER be wrapped around the arm as that can be restrictive an impair circulation.
If you list the other problems you are seeing I can tell you what the standard of care would be in that situtation but you need to be specific for me.
Jan 23, '13
If you have not done this already, I recommend contacting the mfg. rep for the PICC line type you are using. THey have educational materials including videos that you can use. They should also provide inservices for free.
One trick we have incorporated: Only a few (THREE) nurses in our facility can change the central line dressings, including PICC lines (unless there is an emergent reason for someone else to do it). As a result, our central line infection rate has been zero for more than one year.