We do not have a INS certified staff member. We currently change the PICC Line dressing 24 hours after the insertion and then 7 days thereafter. Is the 24 hour dressing change a recomendation throught the standards? The CHG disc company has been quoted to say there porduct replaces the 24 hour change. Any advice is welcomed. Thanks!!
If you are using a transparent semipermeable dressing, you can change it every 7 days. If you are using gauze under the dressing, change it every 2 days. As always, if the dressing is not clean, dry, and intact, or the site has any S/Sx of infection, change the dressing right then with careful inspection.
You can get a copy of the Standards Book from INS. Standard 46 refers to your question.
If anyone in your place is interested in pursuing certification, I would be happy to visit with them. Also, if your facility could send someone to the annual INS conference (It is next April in Las Vegas), that can really jump-start the process!!
Good luck,
Kathleen
Kathleen Wilson, CRNI
What kind of dressing you are going to apply needs to be made after you insert the PICC. If the site is continuing to ooze even after you have applied pressure for a few mins..you can apply the gauze at the site..or you can use some Bioseal...if no oozing...yes you can apply a Biopatch and then change the dressing in 7 days as long as it remains clean dry and intact. A lot of times you can anticipate that they may ooze if you have done a good assessment...are they on any anticoagualtion or have they been recently...low platlets...the frail elderly.....how much catheter you are planning on leaving externally visible (as reverse taper of some products plugs the vein so less oozing ) etc... We were spending a lot of time doing prn dressing changes due to oozing PICCs post placement....we are improved now..b/c we do the pre insertion assessment....we are patient in holding pressure.....we then assess and make our determination of what to do at that point...If you have to do any pull backs after placement you also need to reassess. I often find when I pull back it starts oozing b/c now there is less taper in the vein. On outpatients now I tend to use the bioseal b/c they would leave..and be more active than the typical hospital patient and then have to come right back for a dressing change. If we do apply the gauze dressing we change those at 48 hrs...cahnge the caps as well..otherwise the dressing gets changed again in 7 days and the caps will be 9 days old. The biopatch does not necessarily replace the gauze dressing b/c if it oozing quite a bit..the biopatch is not the answer..the biopatch does have the CHG activity for up to 7 days though..when the biopatch gets sufficiently bloody and then is left to dry..it becomes very hard and I have seen many a skin tear b/c of it. Of course you do not want skin breakdown at or near the inserion site if you can prevent it. So if the bioptach is saturated with blood or fluid... it puffs up..and should be changed and not left to dry.
It might help to understand this if you know where this originated. PICCs originally were place with a large size introducer from a superficial venipuncture then the PICC was threaded in thru this introducer. The introducer was much larger than the PICC and this left a hole in the vein larger than the PICC, thus the increased risk of bleeding within the first 24-48 hours after insertion. Insertion methods have changed and there may not be the same amount of bleeding at the site after insertion. At any time during the dwell time of any catheter - peripheral, midline or central - the dressing must be changed immediately if it is wet, dirty, or non-adherent to the skin. So if there is bleeding change it, if there is no bleeding it does not need changing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861