PICC dressing

[jeane1090]

I have had the worst two days at work. I am a new grad and felt completely overwhelmed by my workload and felt that I could not get ahead of anything no matter how hard I tried. Today I was non-stop busy and did not have time to do my patients PICC dressing. I had planned on doing it when I had a moment after supper break but I got a new admission up that was hypertensive and their condition was deteriorating along with a lot of medical orders. So I didnt get the chance to do the dressing as it was 8 PM before I was able to leave the unit after giving report on my new patient. Should I be feeling anxious over a missed PICC dressing?

[KelRN215, BSN, RN]

Is there a reason the night shift cannot do it before the patient falls asleep?

[LifelongNursing, MSN, RN, APRN, NP]

I would feel personally anxious, but it depends on how you look at it. Don't beat yourself up about it, but at the same time, understand that a PICC dressing that is soiled or out-of-date, should be treated with some urgency as that is a very large infection risk that, in some patients, can cause sepsis, and death without treatment. Yes, that example is extreme, but it DOES happen.

As a new grad, you will learn time-management with experience, but even the most experienced nurses leave late as well. If you have crashing patients or patients that are "too busy" (I don't like that general excuse) don't be afraid to ask for help or, say to someone "hey, do you mind changing so-n-so's PICC dressing, its soiled and out of date, and I'm dealing with this urgency here...."

But despite all of that, during report, you could point out the picc dressing needs changing and asked for help changing it "really quick" or something to that nature, to not put it off on the next shift but to take care of it during report.

With that said, it happens and similar things happen all the time in nursing, don't let it become a habit.

[iluvivt, BSN, RN]

Yes.. If is very important to change the PICC dressing when due and along with that

a needleless connector(NC) change and an isopropyl alcohol scrub of 10 to 15 seconds of the catheter hub before you attach your new NCs.There are several mechanisms,both intrinsic and extrinsic by which bacteria can enter to cause a CLABSI which I can explain if you so desire but this is not something you want to not do because you are busy.I would stay over to do it and do it correctly. .I also wondered why another shift could not get it done as well! All staff must take ownership of the central lines and they must receive scrupulous care that is evidenced based.I can assure you the evidence is there that care and maintenance must be done or your infection rate will go up along with other complications.Are there any specific questions you have about it?

[cleback]

I think you prioritized correctly. If given the choice of treating a symptomatic high BP and changing the picc dressing, I would have made the same choice.

The only thing differently I may have done is to let your charge know you're drowning and could not complete the task. Perhaps she could have found resources for you to help manage the new patient or help with the routine tasks and get you caught up. On nights, there is usually a bedtime med pass so it might have been challenging for the next nurse to do it before the patient went to sleep.