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Discussion

PICC dilemna

Please help!

My pt. is to do PICC infusions q8h at home. His technique is good. My question involves cap changes.PICC is in RAC. He has a 12" extension to allow him to handle his line. I was advised to "change caps daily." Extension tubing remains in place for 3days (whereas IV tubings are changed daily). PICC is capped and extension tubing is capped = 2 caps. It does not make sense to me to change the cap on the actual PICC line because I would then be using the same old extension tubing on it. This situation does not fit "hospital" policies because no extensions are involved. Have tried surfing the web, including Mfr. site, still not sure...

Any opinions appreciated!!!

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    To me, the keyword is "central line"...you set up an infection there, and the patient can be in big trouble.

    You are very correct that unless the tubing is changed, there is no point in changing the cap...however, it should be changed every 72 hours when the tubing is changed, and I would recommend the use of sterile gloves along with scrubbing the area up and down and around the cap with Chlorhexidine (not alcohol), and under the old cap when it's removed, before the new cap is attached and new tubing is used.

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    That cap and extension tubing need only be changed every 7 days and/ or if PICC is used to draw labs it should be changed after lab draw. We do teach our TPN patients to change their cap one extra time during the week and then we change it with the weekly dressing change. Every time that cap is changed the patient increases the potential for infection. Check out INS recommendations.

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    A few questions:

    1. Why do you have two needleless connectors on? Could you connect the extension tubing directly to the PICC hub, and just have a needleless connector on the extension tubing? The purpose of the needleless connector is to facilitate intermittent infusion, so it seems like the needleless connector on the PICC line could be eliminated.

    2. Why were you advised to change needleless connectors daily? Can you just do the needleless connector change with the extension tubing change?

    /Tess Hopkins

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