PICC Line Dressing Change Question

[AgMPLGRL]

Hello Everyone,

I am currently working in a hematology/oncology out patient infusion clinic. We do a lot of PICC Line dressing changes and occasionally run into a debate as to whether or not it is ok to do a dressing change while chemo is infusing. I am actually a medical assistant and it is a medical assistant responsibility to do the dressing changes in our clinic. My clinic director is telling us that it IS ok to do so, however our clinic nurse specialist is saying it isn’t NOT ok. I would just like to reach out to the Allnurse’s community to get a better feel on what is best practice. All your advice is much appreciated.

[Daisy4RN]

You need to check your written policies/procedures. Are you sure you are supposed to be changing PICC dressings at all. Where I come from only RNs can do that (not even LVNs) because of the assessment etc required and especially with Onc pts. Pls check your P/P for more info, you do not want to harm the pt or yourself.

[AgMPLGRL]

I just took a look at our medical assistant scope of practice. It does say that some acceptions to the Illinois medical practice act of 1987 is possible as long as it is passed by our medical center’s quality control officials and the MA passes competencies initially and annually by clinic management. Additionally MAs are unregulated by the state of Illinois. So it is up to the medical center to regulate them based on federal, state, and local laws.

[Daisy4RN]

I have never heard of MAs being allowed to change any CVL dressings, some places do not even allow LVNs to change those. So, does your facility p/p specifically state that you (as an MA) can change the PICC drsg, have you had training and received certification, is this an exception to the rule (scope of MA practice for your state) as stated by your facility and following the laws. If I were you I would really want to know the answers. I am not trying to be snarky, just trying to help you and the patients. So, what did the policy state about changing the dressing while chemo is infusing?

[CharleeFoxtrot, BSN, RN]

2 hours ago, AgMPLGRL said:

Hello Everyone,

...I am actually a medical assistant and it is a medical assistant responsibility to do the dressing changes in our clinic. My clinic director is telling us that it IS ok to do so, however our clinic nurse specialist is saying it isn’t NOT ok. ...

...and this is where you remove yourself out of this power struggle equation by politely telling the clinic director:

With all due respect, while you say it is okay for me to do this procedure, the clinical nurse specialist is saying it is not okay. Can you please advise me as I want to do the best job possible and this is worrying me very much.

[Asystole RN]

(Scope question aside) Technically, I do not think there is anything that prohibits someone from conducting a dressing change during an active infusion but doing so during the infusion of a vesicant, as many chemos are, is ill advised.

During the infusion someone should be assessing for complications such as extravasation and catheter malposition. The dressing change process adds a certain degree of complexity and adds a somewhat higher risk of these complications occurring. The vast majority of dislodgements and malpositions occur during the dressing change process, having an active vessicant infusion turns these complications from a simple delay of treatment to a medical emergency.

It would be difficult to defend this practice.

[Lunah, MSN, RN]

I wouldn't do a dressing change while anything is infusing. It seems like this would be the time when a PICC is at high risk of being dislodged. At least, that seems logical to me.

[AgMPLGRL]

Thank you so much for all of the wonderful responses. I have showed some of them to my nurse manager for more guidance. We are all going to sit down as a group and discuss it more in depth. The advice I’ve received has been very helpful so far!

[myoglobin, ASN, BSN, MSN]

Sometimes, you may not have a choice with certain infusions. For example a patient is on a pressor in the ICU, and has limited IV access. However, in general it is a bad idea. I have (despite my best attempts to be careful) pulled out Picc lines while changing dressings (and seen it happen to others at least four or five times). While this is always a bad thing it is particularly bad when infusing a chemo agent (or most other drugs) both because the drug is lost until access can be replaced, and because it can pose issues with vesicants, and chemical exposure (in the case of chemo agents) to personnel in the area. Also, at our institution, only chemo nurses (not even ICU nurses unless they are certified) can infuse chemotherapeutic agents. One might argue that if you are changing the dressing where this agent is infusing that you are acting (at least in part) as the nurse infusing the agent. Thus, no matter what the policy, it is a less than optimal idea, in my opinion to change dressings during infusions.

[myoglobin, ASN, BSN, MSN]

I would actually add that in the case of certain drugs (ie life saving pressors and even perhaps chemo drugs) maintaining access may be so critical that it would justify delaying changing a dressing (even if it takes you beyond the hospital standard policy) until secondary access can be established.