PICC line question

Posted
by FDBMath FDBMath, ADN, RN Member Nurse

Specializes in Emergency Department. Has 3 years experience.

Hello everyone,

I am a second semester student and have a question. My med-surf clinical instructor stated that removing a PICC line is a sterile procedure. I questioned (in a nice way) why that is the case. She really couldn't answer. I get why inserting them and site care would be, but I don't get why the d/c would need to be. Everything I have found about it just says it is with no reason given as to why. I have no problem doing it using sterile technique, I just am curious why it needs to be.

Any of you more experienced and educated nurses know why the removal would be sterile?

Thanks!

PeakRN

PeakRN

Specializes in Adult and pediatric emergency and critical care. 547 Posts

Removal does not need to be "sterile," we perform sterile dressing changes to prevent/minimize bacterial colonization under the dressing which would eventually move towards the line and potentiat a line infection. When I pull PICCs I just cover the site with a sterile gauze, typically an tagederm, and put a little coban over the whole thing if it is on an adult. I wouldn't be touching the insertion site with a non-sterile glove because it is still a wound per se, but there isn't a need for that anyway.

Some units like the NICU, or with immunocompromised patients, may have policies regarding removing PICCs in a sterile fashion but this is more due to the high risk nature of the patient population rather than the PICC.

Edited by PeakRN
Grammar

cardiacfreak

cardiacfreak, ADN

Specializes in Hospice. 742 Posts

First, tell us why you disagree with your instructor.

FDBMath

FDBMath, ADN, RN

Specializes in Emergency Department. Has 3 years experience. 31 Posts

First, tell us why you disagree with your instructor.

Fair enough. When pulling the PICC, you are removing it from the pt. I get insertion needs to be sterile because you are introducing something into the body. However, removal is removing and not introducing.

On a side note, disagree is rather strong. I just am trying to understand the rationale.

FDBMath

FDBMath, ADN, RN

Specializes in Emergency Department. Has 3 years experience. 31 Posts

Basically the answer I got was because it needs to be sterile on insertion and care. I asked if that is the case, why doesn't pulling a foley need to be sterile?

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience. 2 Articles; 2,847 Posts

I was told once that in rare cases, the PICC line may get "stuck" when you

are pulling it out. Thus the whole area around it would need to be sterile,

in case it actually needs to be left in temporarily.

iluvivt

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience. 2,773 Posts

You need to remove tbe dressing with non=sterile gloves then once all dressing material is off you need to complete the remainder of the procedure using aseptic technique.This would entail removing and suture materials or Secureacath devices then with the pt in the correct position you remove the central line and apply a sterile vaseline gauze or sterile ointment to seal the tract then apply some sterile dry gauze then apply an occlusive dressing.The reason this is sterile is that there is a skin to vein tract and this is considered a wound. This skin to vein tract can allow air into the vascular system and create an air embolism that can kill your patient.The vaseline gauze will seal the tract and the sterile dressing will prevent any microorganisms from entering.Anyone who is just using plain gauze is mistaken and I advice you to change your practice immediately and if policies do not state this they need to be changed as an AE is a never event.I have seen a pt die from a nurse who discontinued a percutaneously placed CVAD with the pt sitting up and not sealing ths skin tract.The pt began to seize then coded and died. Unfortunately ,it was not the only one I have seen.

Wuzzie

4,845 Posts

You need to remove tbe dressing with non=sterile gloves then once all dressing material is off you need to complete the remainder of the procedure using aseptic technique.This would entail removing and suture materials or Secureacath devices then with the pt in the correct position you remove the central line and apply a sterile vaseline gauze or sterile ointment to seal the tract then apply some sterile dry gauze then apply an occlusive dressing.The reason this is sterile is that there is a skin to vein tract and this is considered a wound. This skin to vein tract can allow air into the vascular system and create an air embolism that can kill your patient.The vaseline gauze will seal the tract and the sterile dressing will prevent any microorganisms from entering.Anyone who is just using plain gauze is mistaken and I advice you to change your practice immediately and if policies do not state this they need to be changed as an AE is a never event.I have seen a pt die from a nurse who discontinued a percutaneously placed CVAD with the pt sitting up and not sealing ths skin tract.The pt began to seize then coded and died. Unfortunately ,it was not the only one I have seen.

A PICC line or a different type of CVC?

AnnieOaklyRN

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns. 2,577 Posts

Hi,

The only time a sterile (Sterile gloves and sterile scissors, and a mask) removal will be done is if the PICC line is being cultured (usually the tip of it), otherwise there is not sterility needed.

Unless it is hospital policy there is no need to put more than just a dry dressing over the hole left for PICC line removal, as the vascular entrance is far from the central circulation.

On a side note truthfully when I went to nursing school about 11 years ago I felt most of my instructors lacked the necessary med-surg experience to be teaching and felt a lot of them had no clue, for lack of a better term. For example one of my instructors didn't even know how to use a bladder scanner! I wouldn't argue with an instructor because you will loose and you may become a target, so just do as they say, and learn the real world after. The only time I spoke up against an instructor is when I knew we were giving an elderly patient the full dose of phenergan (when hospitals still gave it), and I knew it was way to much and would put her to sleep for quite a while. I told the instructor I was not giving the patient the full dose and that we needed to cut it in half, the instructor proceeded to argue that I needed to give the patient the ordered dose, and I refused. She promptly told the patient's nurse who then thanked me for not overdosing the patient which may have resulted in a harmful effect. I was a medic and was familiar with some of the meds, this one included, and I knew better than the instructor who was a NP in a clinic. She was a good instructor so there was no hard feelings, but normally I would not have done that, except in this case when it would have harmed the patient.

Annie

Edited by AnnieOaklyRN

NICU Guy, BSN, RN

Specializes in NICU. Has 7 years experience. 4,071 Posts

In the NICU, it is a non-sterile procedure. We place a small vaseline square over the site and cover it with Tegaderm for 24 hrs.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 13 years experience. 3,142 Posts

I wouldn't argue with an instructor because you will loose and you may become a target, so just do as they say, and learn the real world after. The only time I spoke up against an instructor is when I knew we were giving an elderly patient the full dose of phenergan (when hospitals still gave it), and I knew it was way to much and would put her to sleep for quite a while. I told the instructor I was not giving the patient the full dose and that we needed to cut it in half, the instructor proceeded to argue that I needed to give the patient the ordered dose, and I refused. She promptly told the patient's nurse who then thanked me for not overdosing the patient which may have resulted in a harmful effect.

^^ That!!^^

Good job, Annie.

FDB, I think the other question is: what is the policy on the unit about the sterile vs. clean change? You're asking politely and you're to be commended for wanting some best practice info. Follow the policy unless it harms the patient. Good luck!

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience. 1,049 Posts

Basically the answer I got was because it needs to be sterile on insertion and care. I asked if that is the case, why doesn't pulling a foley need to be sterile?

I agree that any IV catheter placed in a sterile fashion, should have its dressing changes done in a sterile fashion.. But the discontinuation of said catheter, unless you are doing cultures, as one said, is aseptic. Our organization will cleanse the site, prior to its removal, but most policies don't even call for that to be done. But just like ILUVIVT wrote... sterile ointment to cover the site along with a sterile gauze and TSM s/p removal.