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Cindybr76
Neonatal PICC line

Question for my neonatal picc team or anyone else that would like to have input.  Our NICU does not change picc dressing changes unless they are indicated. This is according to the NANN guidelines.  When does this change to follow the CDC guidelines of changing the dressing every 7 days.  Any information or direction to literature that supports 7 day dressing change once a patient reaches a certain age would be greatly appreciated.  Thanks Cindy

Angela Lee
I don't think you can assign

I don't think you can assign an age to this question.  In my experience, if the position of the line can be compromised with dressing change because of location perhaps (i.e. axillary entry) or if skin integrity is threatened, I would defer dressing change until indicated(within reason).  With micropremies these issues are more of a concern.  However, a full term infant may be a candidate for weekly dressing changes if he is not so critically ill that it is an added stressor for him.   

Our NICU has infants several months old.  Those dressings can be done every seven days and there are less ill neonates outside of the NICU who also receive scheduled dressing changes.

This is a clinical decision that must be made on an individual patient basis by an experienced vascular clinician or neonatal nurse and should include supporting documentation for delayed dressing change.

Sorry, I don't have any supporting literature but I think it is unlikely you will find any with an age cutoff.

Angela Lee, RN, BSN, CRNI

Cindybr76
Thanks Angela for your input.

Thanks Angela for your input. We had had NICU full term infants but are surgical patients that have PICC lines and we are trying to come to an agreeement when the dressing should be changed every 7 days?  Our neo's feel that they should follow the same guidelines as a premie's. I am concerned not changing these dressing. Some of our neo's have in there past life not changed Broviac dressing either unless indicated and not follow the every 7 days recommendation.  Thanks Cindy

 Cindy Brown RN BSN CPN

IV Nurse Educator/Clinician

lynncrni
 A dressing on a Broviac that

 A dressing on a Broviac that is healed is very different from a PICC. The Broviac will have a subcutaneous tunnel and cuff separating the skin exit site from the vein entry site. After the cuff has healed, a dressing change every 7 days is not the same priority as with a PICC that is a direct percutaneous entry. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Angela Lee
Broviac catheters are

Broviac catheters are initially sutured and after about 3 wks stablilized with the subq cuff so dislodgement is not the same issue as with PICCs.  Infection risk is high in this population as well.  We adhere to a 7 day dressing change for all broviacs or cuffed tunneled lines with rare exception.

Angela

Cindybr76
Thanks for your input.  I

Thanks for your input.  I should also add the the PICC are placed by our IR team and they are 3Fr and our neo's want them maintained the same as PICC placed in the premie population.  Our IR team feel they should be changed every 7 days. We are meeting next week to discuss this process and hoping to find justication in this population that we should be changing them every 7 days.

Cindy

 Cindy Brown RN BSN CPN

IV Nurse Educator/Clinician

Anne Marie Frey
neonatal PICC dressing changes

I think that the NANN premise is that if the PICC is at high risk of being dislodged, the dressing can remain in place as long as it is clean, dry, intact.  We change the 1 and 1.9French PICCs at 48 hours if gauze is in place, then leave the dressing in place unless compromised.  Any catheter larger than the 1.9 French, we change the dressing weekly as these PICCs are more secure on a Stat-Lock. 

Cindybr76
Hi Anne Marie, Question how

Hi Anne Marie, Question how did your team come to the agreement that catheter larger then  1.9 fr would have weekly dressing changes? I would love to chat with you by phone if that is possible.  thanks Cindy

 Cindy Brown RN BSN CPN

IV Nurse Educator/Clinician

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