A PICC line (Peripherally Inserted Central Catheter) is an important part of helping to keep patients healthy and comfortable.
It’s a long, thin tube that goes from the outside of your arm into your vein, and the dressing for this needs to be changed and updated regularly to keep patients in great shape.
We have put together a simple guide with all you need to know about PICC line dressings, including the mistakes and errors to avoid.
What Is A PICC Line?
PICC stands for Peripherally Inserted Central Venous Catheters (see also ‘How To Insert A Coude Catheter‘). They are used to deliver medications directly into the bloodstream through a central venous route.
This type of catheter (see also ‘How To Remove A Central Line‘) is inserted into a large vein near the heart.
They are usually placed in the right internal jugular vein, although they can also be placed in the subclavian vein, femoral vein, or brachiocephalic vein.
They are typically used to administer chemotherapy, parenteral nutrition, antibiotics, blood products, and fluids.
There are two types of PICC lines:
- Single Lumen
These are single-lumen devices that allow only one medication to flow through them at a time. Single-lumen PICCs are generally preferred over dual-lumen because they are easier to insert and remove.
- Dual Lumen
These are dual-lumen devices that can hold up to two medications simultaneously. Dual-lumen PICCs require two separate punctures to place the device.
One is made in the chest wall, while the second is made in the neck. These also tend to be larger and bulkier than single-lumen PICCs.
The type of PICC line used on a patient will depend on what medications are being administered.
Why Do Patients Need A PICC Line In The First Place?
Patients who receive chemotherapy often need a PICC line to administer their treatment. Chemotherapy drugs are given intravenously, meaning they must enter the body via a vein.
If you don’t have a PICC line, then the chemotherapy drug cannot get into your bloodstream. Instead, it stays in your veins and travels throughout your body until it eventually leaves your system.
This means that you could potentially develop side effects like nausea, vomiting, diarrhea, hair loss, mouth sores, and fatigue. You also run the risk of developing an infection in the area where the PICC line was inserted.
What Is A PICC Line Dressing?
A PICC line dressing is a small piece of medical tape that covers the area where the catheter enters your skin.
The dressing helps protect the site from infection, keeps it clean, and allows for easy access when changing the line.
The dressing should be changed around once a week, or when it appears dirty or wet.
How To Change A PICC Line Dressing
There are a number of steps involved in changing a PICC line dressing, and this starts with removing the old dressing first.
This is achieved as follows:
- Sterilize the work area with soap and water, or with alcohol pads.
- Wash your hands for a minimum of 15 seconds with soap and water, and dry thoroughly.
- Sanitize the area by rubbing alcohol pads over the old dressing and pads.
- Carefully remove the tape securing the old dressing to the skin, holding the hub of the PICC line securely on the arm to prevent removal. Loosen the tape and edges of the dressing, and pull it slowly, toward the insertion site.
- Take time to check the site for any sign of infection – this could be torn or red skin, pain, swelling, or pus. If any sign of infection is present, cover the site with gauze and contact a doctor immediately.
Once the old dressing is removed, the new dressing can be applied as follows:
- Wash your hands thoroughly with soap and water, and dry completely.
- Open a new dressing kit by tearing at the corner, avoiding touching any of the items with your bare hands.
- Put on a pair of sterile gloves, and avoid touching the outside of the packaging, or any other items.
- Squeeze the sides of the Chloraprep stick, and clean the site carefully, using a circular motion. Sterilize the area thoroughly, and then allow the area to dry for around 30 seconds.
- Add a BioPatch disk to the area around the line, with the grid side facing up and the foam side facing down, and line the slit and tubing to align.
- Cover the insertion site with a clear dressing, and secure this, applying tape in a crisscross fashion.
- Dispose of any used supplies, and wash your hands thoroughly.
- Check that the patient is happy and comfortable.
Common Mistakes When Changing A PICC Line Dressing
If you follow these simple instructions, you will ensure that you change your PICC line dressing correctly every time.
However, there are some common mistakes that people make when changing a PICC line dressing.
- Failing To Create A Sterile Field
One of the most commonly made mistakes is failing to create a sterile field – and this can lead to serious complications.
When you are preparing to change a PICC line, you must ensure that the entire area is cleaned properly and that no dirt or debris remains. You should also ensure that the area is free of blood and that all surfaces are covered with a sterile pad.
Gloves are essential – these should be worn throughout the process, and they should not touch anything else.
- Incorrectly Using Alcohol Pads
Another mistake that many people make is using alcohol pads incorrectly. You should use them to sanitize the area before starting the procedure, but you should not use them after the dressing has been applied.
This is because the alcohol may damage the adhesive properties of the dressing, which would mean that it might come off during the next dressing change.
- Using The Wrong Size Of Tape
When you are taping the dressing in place, you need to apply enough tape so that it covers the whole area, including the insertion site. You mustn’t leave any gaps between the tape and the skin.
You should also ensure that the tape is tight enough to hold the dressing securely in place, but not too tight to cause discomfort.
- Not Checking For Infection
It is very important that you check the site for signs of infection before starting the procedure (see also ‘How To Find Brachial Pulse‘). This means checking for redness, swelling, tenderness, or any discharge from the wound.
If any of these symptoms are present, you should stop what you are doing and call a doctor straight away.
Final Thoughts
PICC line dressings are important, and keeping the dressing clean and hygienic is an essential element of patient care – this is one skill you should work hard to perfect and improve.