PICC line dressing change: am I in trouble?

  1. 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?
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    About Wheretogo

    Joined: Mar '12; Posts: 4; Likes: 2


  3. by   IVRUS
    First of all,
    MANY Home Health Agencies (HHA) will NOT hire new grads because of the need for that nurse to be autonomous/independant and this isn't usually the case with many new grads. Now, a couple years of Med/surg nursing under ones belt, then yes, HH may be an option... To answer your questions though, supplies can occasionally be an issue in HH, but the nurse seeing the patient should always have extra supplies in his or her trunk, in a waterproof, leak-proof sealed container like plastic bins. What you placed is a gauze dressing which thereby should be changed q 24 hours. A transparent dressing (TSM) like a tegaderm, or opsite placed under sterile conditions can usually stay on, unless it is wet, dirty, or unocclusive, for 7 days.
    (Also remember that that Statlock device is also changed q 7days with each drsg change.)
  4. by   DookieMeisterRN
    First of all tegaderm isn't waterproof and second of all the statlock does not need to be covered. You would need to instruct the client to also cover with some sort of waterproof. Some people use Saran wrap with tape in the home and we also use aqua guards in the hospital.
    It gets difficult now since you've put gauze over the statlock. The tape is now probably stuck to the tegaderm and probably all should be changed since that gauze will most likely not be too sanitary, especially if left on like that for a week.
    Maybe it's done differently though in the home setting and per region but I would def let your manager know.
    Last edit by DookieMeisterRN on Mar 21, '12
  5. by   IVRUS
    The Statlock SHOULD be covered if indeed it is close enough to the site of insertion, as you should have a large area covered to prevent infections. The statlock "people" say it can or cannot be covered and that is true... but in home care, when it's not covered it is harder to keep it secured. Also remember that the purpose of the statlock, or securement device is to keep the IV catheter from moving, and the wings of your IV catheter are what is used to place into the device.
    And yes, if they are showering, the site should be covered along with the area above and below the dressing to prevent the dressing and securement device from getting wet.
    Also, gauze should never be left on for one week.... As said, it is a 24, or 48 hour dressing at THE MOST.
  6. by   Wheretogo
    Thank you for your responses. I did let my manager know what happened. Also, the stat lock was not very close to the site itself. I will have to stock up on supplies for my car though. And I agree that new RNs should have one year experience at least before going into home health. I was at the hospital after graduation for half a year, and succeeded during my intensive fourth year hospital placements, so I felt with hard work and studying, I could make it in home health. I'm doing ok and always ask my supervisor when I'm unsure of something. I am thinking of going back to the hospital part-time though because I want to be as knowledgeable as I can be...
  7. by   MN-Nurse
    Quote from Wheretogo
    And I agree that new RNs should have one year experience at least before going into home health.
    It depends on the company.

    The Home Health and Hospice company I was an aide at hired new grads with no problems. They had a varied patient population with plenty of clients suitable for a new grad. They also provided lots of support by phone and in person if anyone had questions.

    I worked with newbies and the more experienced RNs quite a bit and everybody did fine.
  8. by   Anna Flaxis
    Couldn't you just overlap two of the small tegaderms?

    And, not to pick on you, OP, but I'm in agreement that new grads shouldn't be doing home health. I think it's really important to get some acute care experience to develop your assessment skills before going into an area where you're so autonomous and have to make judgment calls out in the field with no support.
    Last edit by Anna Flaxis on Mar 21, '12
  9. by   Wheretogo
    I suppose I could have tried using several small ones...I guess I figured that as log as the main site was covered with tegaderm...Regardless, I'm really ticked off at myself for this. I think I've learned from this.And don't worry about the "picking on" part. I really wanted to do home health and was disillusioned by the woman who hired me, who thought I'd do great. Don't get me wrong, im meticulous and care for my clients. It's beginning to get clearer though that they don't really care about giving me proper guidance and just want to fill their required nurse visits. Sorry, I'm a bit bitter about my career decision and wish I stayed on the floor longer. I questioned whether this company cared about my license after working there for one month, and after hearing your thoughts, I realize it may be best to get on board on a med/surg unit for a little longer.
  10. by   Anna Flaxis
    I'm sure you are meticulous in your care. I'm glad I didn't offend you with my opinion.
  11. by   KateRN1
    So I'm wondering if you had a PICC line dressing change kit or if this was something cobbled together from individual parts and pieces and if it was all sterile?
  12. by   Wheretogo
    That's a good thing to wonder.
    Well, with this company, you only get a kit on admission. Otherwise, everything is ordered separately. And since I picked up for a sick all, I was not the one who was supposed to do the ordering, and got there, to find not all my necessary supplies available (when 99% of the time, they are). So I had to "cobble" things together; however, they were all in a bag, in sterile packages.

    Side thought: do you think a complex care unit would offer good experience, in comparison to med/surg?
  13. by   MauraRN
    You did the best that you could with what you had at the time. I have gone back to a pt next day to fix something that I had to find a temporary solution to. It is so sad that as nurses we operate under so much fear and stress.
  14. by   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!