A peripherally inserted central catheter, commonly known as a PICC line, is a thin, flexible tube inserted into a vein in the upper arm and threaded into a large vein near the heart, the superior vena cava. This intravenous access is designed for prolonged use, typically for treatments such as extended antibiotic therapy, chemotherapy, or total parenteral nutrition. A PICC line provides a secure, reliable access point for administering medications and drawing blood over weeks or months. Maintaining the line requires strict attention to sterile technique to prevent serious complications like bloodstream infections.
Preparation and Essential Supplies
Before attempting any care procedure, select a clean, organized workspace that is dry, well-lit, and away from potential sources of germs, such as a bathroom. A thorough hand wash with soap and water is the first step against introducing microbes.
The necessary supplies are often provided in a pre-packaged kit. These generally include a face mask, sterile gloves, and an antiseptic solution like Chlorhexidine with alcohol. Other items include a transparent occlusive dressing and a stabilization device, if one is used to secure the line. Put on a mask before opening the dressing kit to prevent respiratory droplets from contaminating the sterile contents.
The Step-by-Step Guide to Dressing Changes
PICC line dressings must be changed routinely, typically every five to seven days, or immediately if the dressing is loose, wet, or visibly soiled. Begin by carefully removing the old dressing while stabilizing the catheter to prevent accidental dislodgement. Gently peel the dressing back from the edges, keeping it close to the skin.
Once the old dressing is removed, inspect the skin around the insertion site for signs of irritation, redness, warmth, or drainage. If a securement device is used, remove it next. A piece of clean tape can temporarily secure the catheter during the cleaning process. The skin is then cleaned using the antiseptic solution, such as a Chlorhexidine/alcohol swab.
The cleaning technique involves scrubbing the area for a set amount of time, often 30 seconds, using a back-and-forth or up-and-down motion. Work outward from the insertion site while scrubbing. After scrubbing, the antiseptic must be allowed to completely air dry for up to three minutes. Do not fan, blot, or blow on the area to accelerate drying, as this can introduce contaminants.
With the site clean and dry, apply a new stabilization device, if prescribed, to anchor the catheter to the arm, preventing movement that could irritate the insertion site. A transparent occlusive dressing is then placed over the site and the catheter hub, ensuring the insertion point is completely covered and sealed. Write the date, time, and your initials on the edge of the new dressing to track the next scheduled change.
Maintaining Patency Through Flushing
Flushing the PICC line cleans the internal tube, or lumen, and prevents blockages, also known as occlusions. This is typically done daily when the line is not in use, or immediately before and after every infusion or blood draw. The procedure requires pre-filled syringes of sterile normal saline, and sometimes a locking solution like heparin, as prescribed by the healthcare provider.
Before attaching the syringe, the needleless connector, or hub, must be cleaned by scrubbing the surface with an alcohol swab for 15 seconds and allowing it to air dry for another 15 seconds. Once dry, connect the saline syringe. The injection is performed using a turbulent, or “push-pause,” technique. This involves injecting the saline in short, rapid bursts—pushing a small amount, pausing briefly, and repeating this action until the prescribed volume, often 10 milliliters, is injected.
The pulsatile action creates turbulence within the catheter lumen, which helps dislodge residual blood or medication that could form a clot. Use at least a 10-milliliter syringe for flushing to avoid generating excessive pressure that could damage the catheter. After the flush, disconnect the syringe while simultaneously clamping the line or relying on the positive pressure mechanism of the needleless connector.
Recognizing and Responding to Complications
Complications can occur, and prompt identification is necessary to prevent serious health issues. Signs of a localized infection include increasing pain, redness, swelling, or warmth around the insertion site. The presence of pus, foul-smelling discharge, or a fever higher than 100.4 degrees Fahrenheit indicates a systemic infection that requires immediate medical attention.
An occlusion, or blockage, is indicated by resistance when attempting to flush the line or an inability to draw blood back. Never force a flush against resistance, as this can damage the line or create internal pressure. Catheter migration may be signaled by a change in the length of the external part of the line or new discomfort in the neck or chest. Any of these signs, including visible damage or leakage, warrant an immediate call to your healthcare provider for assessment and guidance.