An Overview of Peripherally Inserted Central Catheters

Leigh A. Bowe-Geddes, RN, BS, CRNI; Heather A. Nichols, RN, BSN, CRNI

Disclosures

Topics in Advanced Practice Nursing eJournal. 2005;5(3) 

In This Article

Care and Maintenance

Clinical management of PICCs requires sterile technique. The initial transparent dressing at the insertion site is applied over a small gauze pad. The gauze absorbs blood oozing from the insertion site during the first 24 hours after placement. After 24 hours, the initial dressing is removed and replaced with a transparent dressing only. If gauze must be used with subsequent dressings, it should be changed at least every 48 hours. A transparent dressing alone (or with a nonabsorbent securement device or Biopatch [Johnson & Johnson, Somerville, New Jersey] under it) can be left in place longer. The Biopatch is a small foam disc, impregnated with chlorhexidine gluconate. This round patch with a slit fits around the cannula and provides antimicrobial action for up to 7 days.[1,27]

There is no defined frequency for changing transparent dressings, and facility policies vary. Many facilities' guidelines call for changing the dressing weekly or sooner as needed. The dressing must be changed if it becomes wet, soiled, or loose. Patients who shower must protect the site to prevent any water from getting under the dressing.

Flushing protocols vary by facility and type of PICC. Some protocols call for the instillation of heparin solution when the PICC lumen is not in use. However, some catheters are closed on one end by pressure-sensitive valves, and can be flushed with normal saline only. One such device is the BardGroshong (Bard Access Systems, Salt Lake City, Utah) catheter, which has valves on the distal tip. Another is the Boston Scientific PASV (Boston Scientific Corp., Natick, Massachusetts) catheter, which has a pressure-sensitive valve in the hub at the proximal end. Positive displacement valves, which are attached proximally to the catheter hub, are designed to prevent the reflux of blood into the catheter, and some allow normal saline-only flushes. Examples include the CLC2000 (ICU Medical, San Clemente, California), the Posi-Flo (BD Medical, Sandy, Utah), and Ultrasite (B. Braun Medical Inc., Bethlehem, Pennsylvania). All flushing should be done with 10-cc or larger syringes, to prevent excessive flushing force that can damage the catheter.[18]

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