A peripherally inserted central catheter (PICC line) is a long, thin tube inserted into a vein in the arm that extends into a large vein near the heart. This central access device is used to deliver medications, fluids, or nutrition over an extended period. Because the PICC line creates a direct pathway into the bloodstream, maintaining the sterility of the insertion site is paramount to prevent Catheter-Related Bloodstream Infections (CRBSIs). The dressing change procedure upholds this sterility and reduces the risk of infection. Dressing changes should only be performed after comprehensive training by a licensed healthcare professional and strictly following the patient’s specific medical protocol.
Preparation and Gathering Supplies
Before beginning the procedure, preparation of the environment and the caregiver is necessary to maintain a sterile field. Thorough hand hygiene is the first step, involving washing hands with soap and water or using an alcohol-based hand sanitizer. A clean, dry, and draft-free workspace must be established, and the patient should be comfortably positioned with the PICC line arm resting on a clean surface.
A pre-packaged central line dressing change kit contains most necessary items, though additional supplies like a transparent dressing, securement device, or chlorhexidine-impregnated disc may be needed. The standard antiseptic solution is typically 2% chlorhexidine gluconate in 70% isopropyl alcohol, provided in a sterile applicator. Maintaining a sterile field means all items touching the site or new dressing must remain free of contamination, achieved by opening the kit without touching the inner contents.
The caregiver must wear a surgical mask before exposing the catheter site, and the patient should also wear a mask or turn their head away to minimize airborne contamination. Non-sterile gloves are used initially to remove the old dressing and must be discarded immediately afterward. The sterile gloves included in the kit are reserved for skin preparation and applying the new dressing, which are the steps most critical for maintaining sterility.
Detailed Steps for Removing and Replacing the Dressing
The procedure begins with the careful removal of the old dressing, peeling it gently from the edges toward the insertion site. Stabilize the catheter tubing with the non-dominant hand or a piece of tape to prevent accidental dislodgement during removal. Alcohol pads can be used to loosen the adhesive, easing removal and reducing potential trauma to the skin.
After removing the old dressing and any securement device, thoroughly inspect the site for signs of complication, such as drainage, redness, swelling, or skin breakdown. Discard the non-sterile gloves, perform hand hygiene, and don the sterile gloves before preparing the sterile field. Clean the insertion site using the chlorhexidine applicator, scrubbing with friction in a back-and-forth pattern for a minimum of 30 seconds.
Mechanical friction helps the antiseptic solution penetrate the skin where microbes reside, and the cleaning area must extend beyond where the new dressing will be placed. After the 30-second scrub, allow the antiseptic solution to air dry completely, typically 30 seconds to two minutes, depending on the product. The agent must be entirely dry to achieve its maximum antimicrobial effect and prevent skin irritation.
Once the site is dry, a skin protectant may be applied to the surrounding area, avoiding the immediate insertion point, to shield the skin from the new adhesive. A chlorhexidine-impregnated sponge disc is then positioned around the catheter exit site for continuous antimicrobial protection. Next, apply the new securement device, such as a StatLock or SecurAcath, ensuring it is not placed in the exact spot as the previous one to protect the skin.
Finally, place the new sterile transparent dressing over the insertion site, the antimicrobial disc, and the securement device, ensuring the entire area is covered and sealed. The dressing’s transparency allows for continuous visual inspection of the insertion site without removal. Document the date, time, and initials of the person performing the change on the provided label strip and affix it to the outside of the dressing.
Site Monitoring and When to Seek Medical Help
Vigilance is necessary after a dressing change to detect potential complications early, as the PICC line remains an entry point for infection. Caregivers and patients must routinely inspect the arm and the dressing for any changes between scheduled changes. If the dressing becomes soiled, wet, or begins to lift at the edges, it must be changed immediately, regardless of the weekly schedule.
Signs of a localized infection at the insertion site include increased pain, warmth, redness (erythema), swelling, or the presence of pus or abnormal drainage. These indicators require immediate medical attention. Systemic signs of infection, such as fever above 100.4 degrees Fahrenheit or chills, also warrant urgent contact with the healthcare provider.
Other serious complications require immediate medical contact or emergency services. These include swelling in the face, neck, or arm, which may indicate a blood clot. Also watch for a cracked, leaking, or migrated catheter, sudden difficulty flushing the line, or the presence of chest pain or shortness of breath. Prompt intervention minimizes the risk of serious health consequences.