PICC line dressing changes in the NICU

[Nurse Ali]

I am a nursing student doing my final rotation in the NICU. At the facility I'm at, they have a protocol for changing PICC line dressings every 3 days. For my final project I want to try and get this protocol changed. I was wondering if there is any research out there to support and increase risk of infection related to dresssing changes being done too frequently. I was also wondering what the normal protocol is in other NICU's.

Any information or links any of you could provide would be great. Thanks!

[URBANNURSE]

In my facility, we don't have a protocol for NICU PICC dressing changes.

We change them only prn to prevent any pulling out of the lines and to decrease infection. I'm sorry I don't have any research materials to share with you.

[smithabbyp]

I am very interested in what you find on dressing changes...I am presently working on a power point presentation for the staff in our Level IIIA unit.

Thanks,

smithabbyp

[jesran]

We now have an Infusion Support Team at my hospital located in a major US city. I am a member of this team who's unannounced mission is to reduce blood stream infection rates throughout the hospital, especially in the critical care units.

To answer the question at hand: Our protocol for dressing changes is Q7Days or PRN everywhere including the NICU, however part of our routine is having a team member assess each dressing everyday.

We've seen tremendous results lately. The CDC benchmark we happen to utilize, the 50th percentile rate for central line related blood stream infections in critical care units, has been surpassed easily for the last 3 or 4 months. Historically that benchmark was not even realistic here. Our team has been out of pilot phase for less than one year.

There are many reasons for our recent success, but I think foremost is having a team of trained nurses with a clear goal.

[kmande]

GO to the CDC website or Infusion Nurses Society resources. The CDC recommends CL drg change weekly. Some NICU resources only change PICC drgs when wet or dirty. Every three days probably increases the likely hood of infection and the risk of accidental removal.

[PICC RN]

Because of skin integrity issues in the neonate, PICC line dressing changes should be performed after the 1st 24 hours, and then prn thereafter. After the initial PICC insertion, there may be some bloody drainage on the dressing, which needs to be changed to prevent bacterial growth. A clear transparent dressing may replace the initial dressing and remain in place unless soiled or dressing integrity is compromised. The site must also be assessed for signs of infection as well. Constant removal of these occlusive dressings can wear havoc on delicate neonatal skin, creating irritation, skin shearing/stripping, and another port of entry for infection.

[kmande]

Smithabbyp - I can give you some info/resources for PICCs/central lines.

[BittyBabyGrower, MSN, RN]

We change the first dressing 24 hours after insertion, preferably with the person who put it in and should know what it looked like! We then change them prn for wetness/soiled/becoming loose or if there is edema from being sick/vec'd/etc and the dressing is pulling. For neonates, also remember that there should never be a steristrip on the cath itself...steristrips have a thread that runs thru them and can actually occlude the line.

When we change them it is with a central line kit, just like a broviac.

We too have implemented a central line bundle with this included and we have fallen way below benchmark! It used to be people were afraid to change the dressings, but now our fellows and NNP's are more in tune and willing to help. The changing of the first dressing has made a tremendous difference! The CDC recommendations are clear occlusive dressings q7days or if there is a dressing under the occlusive dressing q72hours, but it is written into our hospital policy about not changing, unless on of the forementioned conditions exists.

Some other sources to look into are the PICC companies themselves and IHI.org .

[EHRN]

We don't have an NICU, but I'll share what we do. We have pre-written standing orders for our PICC lines that includes an initial dressing change 24 hours post insertion. At this 1st drsg change, a biopatch is placed. Then, our protocol/standing orders states that the dressing should be changed every 7 days (with biopatch) and PRN. We use Statlock about 95% of the time, and these get changed out with the dressing changes as well.

[BittyBabyGrower, MSN, RN]

Please remember though, biopatches aren't approved for use in small neonates. We are looking into whether we can use them on bigger kids, over a certain weight.

[rehabhereIcome]

how long will there be brusing at the insertion site after initial placement? this is normal correct...as is the dried bits of blood

[BittyBabyGrower, MSN, RN]

We rarely have bruising at the site and if there is dried blood under the dressing, then it should be changed out as this is a source for infection.