› PICC Dressing Change

The PICC Dressing Change

Depending on your facility, you and your patient may or may not need to wear a mask. Out West my agency didn’t expect it. Back East, everyone wears a mask. 

The first PICC dressing change is 24 hours after initial insertion or if there is ever a gauze on the insertion site. After that, the dressing is changed every 7 days. 

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The PICC is usually in the inner upper arm. Make sure you position the patient’s arm so you can get to it without contaminating sterile gloves. It may be awkward for the patient but you need to be able to get to it, so position the arm for your procedure appropriately.

Bruising and some dried blood at the insertion site is normal in new PICC lines. Small amounts of bleeding at the site of a brand new PICC occasionally happens. Large amount of swelling, pain, redness, lots of blood or a fever is a problem you need to contact the infectious disease doc that is managing the IV infusion.

Demonstration of a PICC Dressing Change

Finding a good PICC dressing change video was pretty near impossible. This is the best I could find. I’ve made comments about it:

Most videos including this one don’t show changing to sterile gloves once the outer dressing is off. 

WRONG!!!! 

If the statlock and bio-disk were sterile when put on, it is still sterile when taken off. So change to sterile gloves once the outer dressing is off.

If you are concerned because everyone else is not using the sterile gloves until after the removal of the statlock, then use sterile gloves to remove the statlock then replace with a new set of sterile gloves for cleaning of the area and replacement of the dressing.

And don't forget to use hand sanitizer every time you remove your gloves.

using hand sanitizer

Normally, alcohol will not help release any adhesive but the statlock adhesive is different and sensitive to alcohol so you can use the sterile alcohol swabs in the PICC dressing change kit to get it off easily if need be.

Be very careful when removing the stat lock that you don’t let the PICC dangle because it is heavy enough to pull the line out. Once the line is secure you can measure from the insertion site to hub. DO NOT PICK UP A PEN WITH YOUR STERILE GLOVES TO WRITE DOWN THE LENGTH!! Just remember it.

If there is greater than 2 cm difference from the last week’s measurement you need to contact the physician as it needs to be x-rayed again to make sure the end of the line is still in the superior vena cava.

When cleaning with a kit that has Chlorhexidine scrub back and forth. When cleaning with Betadine, first make sure your patient isn’t allergic to iodine. Then clean in expanding circles, let dry then remove betadine with the alcohol swabs and let dry. Don’t fan and don’t blow dry.

Apply skin prep to the entire area to protect the skin and help adherence. Let dry.

The Bio-disc is good for 7 days. The blue side is on top and the white side is next to the skin. DO NOT put the PICC line on top of the bio disc and then place the transparent dressing over them as shown in the video at 4:44. The blue of the bio disc sticks to the transparent dressing FOR-EV-ER!!  You will never be able to separate them and you won’t be able to get the PICC line free.

Been there done that. Instead, have the tube snug in the slit of the Bio-disk so it is in touch with the antimicrobial sponge.

At around 5:30 in the video, you will notice that the nurse is peeling off a small piece of cloth adhesive that was on the border of the transparent dressing. That gets placed under the PICC line tubing and over the transparent dressing border to help keep the line from pulling out. 

Statlock Use In PICC Dressing Change

Before you try to put the new statlock on, bend the top clamps once or twice as they are pretty stiff and can be awkward to maneuver 

If you have small hands like I do and the gloves are super huge as most kits are, this is going to be a tricky part because the fingers of the gloves are going to get in the way of the little moveable prongs. Try to push the index finger and thumb of the glove up to get rid of any slack when you get to this point so you don’t have a ton of glove getting in the way.

If this doesn’t make sense now, just wait ‘til the first time you do this. You will understand what I mean.

Make sure the placement of the statlock doesn’t kink the tubing. Usually Purple Power PICCS are pretty thick, but the thin blue PICCs easily kink. You can curve the tube to avoid the antecubital area or in order to keep the entire line under a dressing but don’t make any sharp turns. 

Measure circumference of the arm at the insertion site after the dressing is on. An increase in circumference means inflammation and probable infection. Time to call the Infectious disease doc or the IV infusion vendor

There is also another small piece of tape on the border of the transparent dressing that you can use to put the date, your initials, the circumference (circ) of the arm and the external length (ext) of the PICC line. This info will also go into your notes. 

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