A Peripherally Inserted Central Catheter (PICC line) is a thin, flexible tube inserted through a vein in the upper arm, with its tip resting in a large vein near the heart. This placement allows for the long-term delivery of medications, such as extended antibiotic therapy or chemotherapy, and nutritional support. Because the catheter tip sits in a central blood vessel, strict adherence to medical instructions and a sterile technique is paramount. Maintaining a clean insertion site and a functional line is the primary responsibility for preventing a potentially serious bloodstream infection.
Essential Supplies and Preparation
Successful PICC line care begins with meticulous organization of supplies and the environment. A pre-packaged dressing change kit is often provided, typically containing sterile gloves, a mask, an antiseptic solution like chlorhexidine, a new transparent dressing, and a securement device. Before opening any sterile items, the caregiver must perform thorough hand hygiene, washing with soap and water for at least 30 seconds, and preparing a clean, clutter-free workspace. This preparation should take place in a dry area, avoiding moisture-prone rooms like a bathroom, to minimize contamination risk. Both the caregiver and the patient (if unable to turn their head away) should wear a face mask to prevent germs from contaminating the insertion site.
Step-by-Step Sterile Dressing Change
The process of changing the dressing requires maintaining a sterile field around the insertion site. After donning clean disposable gloves and a mask, the caregiver gently peels the old transparent dressing away from the skin, moving toward the insertion site. The catheter must be stabilized to prevent accidental movement or dislodgement. The old securement device is then removed, and the site is inspected for complications like redness, swelling, or drainage.
After removing the clean gloves and performing another hand washing, the caregiver applies sterile gloves to handle the remainder of the supplies, which must be kept on a sterile field. The next step is the antiseptic scrub, using a chlorhexidine-based swab to clean the skin around the catheter exit site. This cleaning must be done with friction, moving from the insertion site outward in an expanding circular or back-and-forth motion, scrubbing the catheter wings and surrounding skin for at least 30 seconds.
The antiseptic must be allowed to air dry completely, which usually takes between 30 seconds and one minute. Chlorhexidine is most effective when fully dry and can irritate the skin if the dressing is applied prematurely. Following the cleaning, a skin protectant may be applied to the surrounding skin, avoiding the immediate exit site, to help the new dressing adhere.
The new securement device is then placed to anchor the catheter and prevent movement, which is a common cause of complications. If an antimicrobial patch is prescribed, it is placed over the exit site with the slit aligned with the catheter. Finally, a new transparent film dressing is applied over the entire site, ensuring the insertion point and the securement device are fully covered and the edges are sealed. The dressing should be dated, timed, and initialed to track when the next weekly change is due.
Maintaining Line Function Through Flushing
Routine flushing maintains the internal functionality of the PICC line to prevent blockages. Flushing involves using a pre-filled syringe of sterile saline, and sometimes a heparin solution, to clear the line of blood or medication residue. It is important to use a 10 mL syringe or larger for flushing, as a smaller bore syringe can generate excessive pressure that risks damaging the catheter wall.
The injection cap must first be thoroughly scrubbed with an alcohol pad for at least 15 seconds and allowed to air dry completely to prevent introducing bacteria. The flush is administered using the “push-pause” technique, where the plunger is depressed in rapid, short bursts rather than a steady stream. This turbulent flow helps to dislodge any fibrin or drug particles adhering to the inner catheter wall.
When the final milliliter of flush solution is injected, the catheter clamp should be closed, or the syringe disconnected, to create a positive pressure inside the line. This positive pressure prevents blood from flowing back into the catheter tip, which could lead to clot formation and occlusion. Injection caps are a potential source of infection and should be replaced with a new, sterile cap at least once a week, often during the dressing change.
Recognizing Potential Complications
Vigilance for complications is essential, as problems can develop quickly and require immediate medical attention. Signs of a localized infection include increasing redness, swelling, or warmth at the insertion site, or the presence of pus or foul-smelling drainage. Systemic infection is indicated by a fever above 100.4°F, chills, or generalized flu-like symptoms.
Difficulty with flushing or infusion may signal a line obstruction, manifesting as sluggish flow, an inability to aspirate blood, or frequent infusion pump alarms. Other mechanical issues include the line accidentally coming out, a change in the external catheter length, or pain in the arm, shoulder, or chest during flushing. Recognizing these warning signs early and contacting the healthcare provider promptly is crucial, as intervention is often required to address the complication and prevent further health risks.