A Peripherally Inserted Central Catheter (PICC line) is a long, thin tube inserted into a vein in the arm, with its tip resting in a large vein near the heart. This device provides long-term intravenous access for administering medications, fluids, or nutrition over weeks or months. Maintaining the integrity of the PICC line dressing is paramount to preventing a central line-associated bloodstream infection (CLABSI). Dressing changes require a sterile technique, and this guide should be used only by patients or caregivers who have received formal training from a healthcare professional.
Gathering Supplies and Preparation
The process begins with meticulous preparation to establish a clean and controlled environment for the procedure. You will need a complete PICC line dressing change kit, which typically contains sterile gloves, a mask, an antiseptic agent like a Chlorhexidine Gluconate (CHG) swab, a transparent dressing, and often a securement device. Ensure the area where the change will occur is clean, dry, and well-lit, avoiding damp locations like a bathroom.
Before opening the sterile kit, perform thorough hand hygiene by washing your hands with soap and water for at least 30 seconds, drying them with a clean paper towel. Both the person performing the change and the patient should wear a face mask to prevent respiratory droplets from contaminating the site. Setting up the supplies on a clean, uncluttered surface allows for a smooth, uninterrupted process necessary for maintaining sterility.
Removing the Old Dressing and Cleaning the Site
The first step is to put on non-sterile gloves and gently remove the existing dressing. Start by carefully peeling the edges of the old transparent dressing away from the skin, pulling low and slow toward the insertion site to minimize trauma. Stabilize the catheter tubing with one hand while the dressing is peeled away with the other.
Once the old dressing is removed, inspect the insertion site and the dressing itself for any signs of excessive drainage, redness, or swelling. Any unusual findings, such as thick or colored discharge, should be noted immediately and reported to a healthcare provider. After discarding the non-sterile gloves and the old dressing, perform hand hygiene again before proceeding to the cleaning phase.
The cleaning process requires strict adherence to sterile technique, starting with donning a new pair of sterile gloves. The preferred antiseptic is a Chlorhexidine Gluconate (CHG) swab, which is highly effective against microbes. Scrub the insertion site with the CHG swab using firm friction, moving outward from the catheter insertion point.
The scrubbing action should cover a wide area for at least 30 seconds, including the catheter tubing near the exit site. After cleaning, the antiseptic must be allowed to completely air dry for up to 30 seconds, or as specified by the product instructions. This drying time is critical for the CHG to become fully active and kill microorganisms; do not fan or blow on the area.
Applying the New Securement Device and Dressing
Following the complete air-drying of the antiseptic solution, the catheter must be secured to prevent movement, which contributes to infection and catheter damage. A securement device, such as a StatLock, is applied to anchor the catheter tubing firmly to the skin, mitigating the risk of accidental pulling or dislodgement. Apply the securement device according to the manufacturer’s instructions, ensuring the catheter is held without tension.
After the securement device is in place, a new sterile transparent dressing is applied directly over the entire insertion site and the securement apparatus. Transparent dressings allow for continuous visual inspection of the site while providing a microbial barrier. The dressing should be applied smoothly without wrinkles, ensuring a tight seal on all edges to prevent bacteria entry.
Some dressings may include an integrated antimicrobial gel pad, which is placed directly over the insertion site. Finally, the dressing should be labeled with the date and time of the change, along with the initials of the person who performed the procedure. This documentation is important for tracking the next scheduled change, which is typically every five to seven days, or sooner if the dressing becomes loose, wet, or soiled.
Monitoring for Post-Change Complications
Vigilance following the dressing change is necessary to ensure the PICC line remains functional and free from complications. Inspect the insertion site for localized signs of infection, including increased redness, warmth, swelling, or pain. Any yellow or green purulent discharge is a clear indication that an infection may be present and requires immediate medical attention.
Monitoring for systemic signs of infection, such as a fever of 100.4°F or higher, chills, or unexplained malaise, is also important. These symptoms may suggest a more serious bloodstream infection. Mechanical complications, such as catheter migration, can be indicated by changes in the external length of the catheter or swelling along the arm, neck, or shoulder.
If any concerning signs of infection or mechanical issues are observed, contact the home health nurse or physician without delay. Prompt reporting allows for timely intervention, such as culturing the site or initiating antibiotic therapy. Maintaining open communication with the healthcare team is a necessary part of PICC line care.