Care and Maintenance
Dressing Change Frequency
Transparent dressings are changed every 7 days.
Dressings containing gauze are changed every 48 hours.
(If StatLock© present, please change with every dressing change)
Gather supplies:
- Clean gloves
- Sterile Central line dressing change kit
OR
- Sterile gloves
- Mask (2)
- 2% Chlorhexidine-70% alcohol applicator
- Sterile transparent dressing with Chlorhexidine (CHG) or a sterile transparent dressing if chlorhexidine is contraindicated for the patient.
- Sutureless securement device ("StatLock" ©) as needed for PICC line
- Alcohol/povidone iodine swabstiks - 3 each, if chlorhexidine is contraindicated for the patient.
Preparation of Equipment
- Perform hand hygiene
- Inspect all IV equipment and supplies
- Clean and disinfect the work surface using a facility-approved disinfectant, as needed, to prepare for setting up a sterile field
Steps:
- Obtain assistance of second caregiver if patient cooperation cannot be assured due to age or altered mental status.
- Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
- Apply clean gloves.
- Apply mask to patient or ask patient to turn head away from catheter site.
- Apply personal protective equipment (PPE) such as gown and cap per protocol.
- Remove dressing and dispose in waste container.
- Remove gloves and dispose in waste container.
- Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
- Apply sterile gloves.
- Pinch the wings on the Chlorhexidine-70% alcohol applicator to break the ampule and release the antiseptic onto the sponge pad.
- Clean area approximately 2 inches around the catheter exit site with the chlorhexidine applicator. Use a back and forth motion for 30 seconds to clean site.
- If using alcohol and povidone iodine, clean in a circular motion from the PICC exit site outwards approximately 2" in diameter.
- Allow the area to air dry for 30 seconds.
- Secure catheter with Advance CHG Tegaderm and/or sutureless securement device ("Stat-Lock" ©)
- Note date, time and initials on dressing.
- Document the date and time of the procedure and assessment of the site in the patient's medical record.
- No flush is recommended for continuous infusions
- Variations in practice for a specific population may be guided by unit protocols.
- All PICC lumens are flushed with 10 ml normal saline
- After intermittent IV medications and infusions
- After blood draws
- Every 12 hours if lumen is not in use
- Flush should ensure no visible blood is in cap.
- Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
- Apply clean gloves.
- Scrub external surface of the cap(s) vigorously with approved antiseptic for 10 times.
- isopropyl alcohol 70%
- chlorhexidine gluconate 2%-isopropyl alcohol 70%
- Allow antiseptic to air dry on site.
- Always use a 10 cc syringe or larger. Smaller syringes put too much pressure on the PICC line and may cause damage to the catheter.
- Flush using the "PUSH-PAUSE" method. Simply push a small amount of saline into catheter, pause, and then push some more in. Repeat this step until total flush is given.
- Clamp the PICC before disconnecting the syringe.
- Flush all lumens twice a day even when not in use.
- Document intervention in patient's medical record.
- If resistance is encountered while flushing initiate the declotting protocol utilizing t-PA (Cathflo).
**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures - Central Venous Catheter Care (Nur-HS 104)
Changing the Injection Cap: Also referred to Needless connector
This is required once every 4 days.
- PICC caps are changed every 96 hours or if blood or debris is observed.
- Gather supplies on a clean, stable work surface:
- Chlorhexidine-70% alcohol applicator (1)
- Clean gloves
- Sterile cap(s)
- Prefilled 10 mL syringe containing normal saline
- Disinfectant end cap containing 70% isopropyl alcohol. Common brand is the 3 M Curos
- Three (3) 70% isopropyl alcohol swabstiks and three (3) 10% povidone iodine swabstiks may be used if patient has Chlorhexidine allergy.
- Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
- Apply clean gloves.
- Open the cap package while maintaining the sterility of the syringe tip; attach the prefilled syringe containing normal saline to the new cap.
- Flush the cap with normal saline solution to purge the cap of air. Leave the syringe in place.
- Close the clamp between the cap and the catheter.
- Remove the existing cap.
- Perform a vigorous mechanical scrub of the catheter hub for at least 5 seconds using an antiseptic pad. Allow it to dry completely.
- Remove the protective cover from the flushed cap.
- Attach the flushed cap to the catheter hub. Rotate to tighten, taking care not to overtighten.
- Unclamp the catheter and aspirate slowly for a blood return.
- If you obtain a blood return, inject normal saline solution slowly into the catheter.
**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures- Central Venous Catheter Care (Nur-HS 104)
- Fibrin accumulation can cause partial or complete blockage of a PICC. Administration of a thrombolytic agent can be safely given to clear a blockage of the internal lumen of the PICC.
- Indications:
- Partial or complete occlusion of the PICC
- Difficulty flushing the PICC
- Inability to withdraw 3mls or > of blood from the PICC.
- Contraindications: If additional symptoms such as swelling of the PICC arm, leaking from the insertion site, or pain along the PICC tract t-PA (Cathflo) should not be administered until ultrasound can be performed to rule out vascular thrombosis.
- Midlines terminate in a peripheral vein. Due to the tip location, blood aspiration from a midline may not be possible and not considered a blockage.
- If a PICC malposition is suspected, a chest x-ray should be ordered to confirm tip location prior to administration of t-PA (Cathflo).
- Procedure:
- Obtain order for t-PA (Cathflo). See CVC Care Grid for specific dose recommendations.
- Gather supplies on a clean, stable work surface:
- 2% Chlorhexidine-70% alcohol applicator
- Two (2) sterile gauze pads or two (2) alcohol prep pads
- Clean gloves.
- Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 15 seconds.
- Apply clean gloves.
- Scrub from the connection between catheter and cap outward in a circular fashion using Chlorhexidine-70% alcohol applicator.
- Extend cleansed area approximately 1 inch on either side of the catheter and cap.
- Stop infusions and clamp lumen of the PICC lumen to be declotted.
- With alcohol prep pads or sterile gauze wrapped around both sides of the junction, remove the cap from hub.
- Attach t-PA (Cathflo) syringe to the hub.
- Unclamp the lumen.
- Slowly instill using a gentle push-pull motion on the plunger of the syringe.
- Clamp PICC and connect hub to a new primed cap.
- Leave t-PA (Cathflo) in place for 120 minutes.
- After 120 minutes, unclamp PICC and attempt to aspirate drug and 5ml of blood.
- If successful, irrigate CVC with 10 mls of normal saline. Replace cap(s) or tubing to resume IV.
- If unable to aspirate, clamp PICC and wait another 30-60 minutes.
- If unsuccessful, consult with MD/designee re: order for repeat administration of t-PA
**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures-Central Line Care (Nur-HS 104)
- Please take the following steps for patients who present to the UCLA Health System with an existing PICC line:
- Contact the medical team to order a portable chest x-ray order to confirm catheter tip placement.
- Perform a sterile dressing change if due or the dressing is not secure.
- Note the length of catheter external to the body in the LDA flowsheet.
- Do not use the line until a physician has provided an order "OK to use PICC" or "OK to use MIDLINE".
- To remove PICC lines within the UCLA Hospital System you need to exhibit competency.
- Cornerstone has Adult and Pediatric PICC removal training modules. These should be completed as part of the Competency training.
- Once PICC removal proficiency is achieved, your Unit Manager / Educator can document competency.
- Competency is reviewed on an annual basis.