IVmama58

additional info for PICC line maintenance from one who works in home infusions, we always measure mid arm circumference when doing a dressing change as another way to evaluate the PICC. I can't stress enough also to make sure the area that you cleanse is COMPLETELY dry before applying the dressing. Many patients end up with a rash similar to a first degree burn because chloraprep which is very caustic, is still wet/damp and placed underneath an occlusive dressing. Also, many patients come to us from the hospital setting without the dressing being completely sealed. A piece of sterile tape or the part that comes with the dressing needs to be UNDER the PICC and another piece OVER the base of the dressing to prevent bacteria from having an easy entry under the dressing. I teach my home care patients, that if they are hospitalized they need to make sure their nurse washes their hands, Scrubs the Hub, flushes with at least 10 cc after blood draws and is trained and competent in PICC line/CL care prior to touching their line. Line infections cost millions of dollars every year as well as risk to the patient's life. Simple steps take care of and prevent them. No excuses of being too busy to provide quality line management are acceptable! :)

Thanks for your responses. Actually, there have been some significant rashes with a couple of the nurses. We have repeatedly reminded them to allow the area to dry for at least a minute. Honestly, the company I work for uses a dressing kit with the company logo on it. And that it is made in Mexico. We do usually switch either to a different kit ie Excel (alcohol/betadine mix) or the good ole' fashioned alcohol and betadine. OR we switch to a different type of dressing like IV 3000 or Opsite. We never switch both at the same time so as to see which was perhaps the culprit. well, will continue to do as we have as it sounds like we are doing everything alright. And as for the CDC recommendations. HMMMM not sure how much I buy into chloraprep being better than alcohol and betadine. Line infections still occur. And not sure how much they have decreased with the chloraprep. So, many things come into play when considering outcomes. :)

thanks so much for your reply! The kits we have are imported from Mexico and we are wondering if it is perhaps that the chlorahexidine solution is too strong or is it that some of the nurses do not allow it to dry before placing on the dressing.

Interested in knowing if anyone else has problems with rashes caused by chloraprep on PICC sites. Work in home infusion and there appear to be some nurses who do not allow it to dry prior to applying the dressing itself. This results in a contact dermatitis reaction that sometimes is so intense it actually spreads beyond the site. I switch to a different dressing kit with Excel or Povidine and Alcohol and switch the dressing as well. Anyone else encountered this? Just curious if it is perhaps widespread or isolated to the specific dressing kits we use. thanks:nurse:

Great job! The only thing is when making the dressing truly occlusive at the end, a piece of tape should be notched and placed under the needle extension at the edge of the dressing and another piece on top of the tubing directly over the piece just placed under the tubing. Otherwise there is still the possibility of bacteria entering under the dressing.

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.

Recently, I have been busy accompanying my elderly dad and mom to doctor's appts, day surgery, and ER visits. They have asked that I am present to listen and ask questions as I see fit. I do not act threatening or intimidating but as their advocate who happens to be a RN. My parents are proud of my profession and I don't mind that they share that. I do notice that the MDs, RNs and NPs then also include me when engaging in conversation. With the many mistakes I have witnessed being made, I want them paying attention to what they are doing. If knowing there is a medical professional watching makes them more aware and proactive then so be it.

If you would like to develop finer palpation skills to be able to feel the veins try this. Take a phone book or yellow pages book. Place a single strand of your hair between 2 pages and practice feeling for it. Add additional pages one at a time and keep practicing to fine tune that ability to palpate even the veins you feel are impossible! It really works! Good luck!