A peripherally inserted central catheter (PICC) is used for patients needing venous access for I.V. fluids, long-term antibiotics, chemotherapy, or total parental nutrition (TPN). A PICC is also used for drawing blood.
Who can't use a PICC line?
Patients with an implanted defibrillator or pacemaker may not be able to have a PICC line. Alternatively, these patients can have the PICC line inserted on the opposite arm to avoid interfering with the pacemaker wires.
The patient must have a normal heart rate for a PICC line to be effective.
PICC line placement may be contraindicated for some patients with chronic kidney disease. Patients with elevated BUN and creatinine levels and a low glomerular filtration rate (GFR) typically need clearance from a nephrologist before a PICC line is inserted. If the patient is a candidate for dialysis and requires long-term arteriovenous access, inserting a PICC line can decrease the potential access sites for a future fistula or shunt, according to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative. Also, placing a PICC line increases the risk of developing deep venous thrombosis.
Maintenance of PICC Lines
Assess the PICC insertion site for redness, tenderness, or swelling. To keep an eye on any swelling, the patient's arm circumference can be compared with the baseline measurement taken before PICC line insertion.
Assess the dressing to make sure it's clean and intact. If the edges start to peel away or are soiled or bloodied, the dressing may need to be changed. A PICC dressing usually includes an antimicrobial patch, an adhesive device to keep it in place, and a transparent dressing. Always date and initial the dressing.
Assess the blood flow while flushing the catheter. The line should be easily aspirated and flushed without any resistance. If resistance is experienced during flushing, check the unit for clots or kinks in the line. If there are no obvious problems the line may need to be flushed with a special declotting agent.
Reserve one port if the PICC is being used for Total Parenteral Nutrition (TPN). If the patient is receiving TPN, one port should be reserved for only TPN. To decrease risk of bacterial contamination, no other medications or I.V. fluids should be infused through this port.
Don't take blood pressure on the arm with the PICC line.
Remove the PICC if IV therapy is discontinued. PICC lines are easy to remove.
- Wash your hands thoroughly with antibacterial soap and put on a new pair of sterile gloves.
- Materials needed: sterile scissors, air-occlusive dressing, stitch cutter, sterile dressing packages and cotton balls soaked in betadine solution.
- The patient should be lying flat on his or her back, facing upwards, with all four limbs in contact with the bed.
- Using a stitch cutter, carefully cut and remove the suture that holds the PICC line in place. Ask the patient to hold his breath, then, using your dominant hand, slowly pull the catheter out in the opposite direction of insertion. Do not apply any direct pressure on the insertions site.
- Once the catheter is removed, immediately cover the insertion site with sterile gauze and hold it in place using light pressure.
- Ask the patient to continue holding their breath while you cover the area with an occlusive dressing. Once this is done, allow the patient to breathe normally and return to a comfortable position.
- After the removal monitor the patient’s condition for 24 to 48 hours. Observe the patient for signs of infection such as fever. Also, observe the site for bleeding and assess the patient for any difficulty of breathing.
- The dressing should remain in place for 24-72 hours, depending on the length of time the catheter was used.
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