A PICC LINE NEGLECTED IS A PICC LINE INFECTED Clinical Guideline (Adult)

The Clinical Question In adult patients with PICC lines, what are the best practices related to routine care, medication infusion, and maintaining patency to reduce complications?

COMPLICATIONS Heparin-Induced Thrombocytopenia Syndrome (HITS) Allergic reaction to heparin Catheter occlusion Catheter Related Blood Stream Infections (CRBSI) *Heparin- Induced Thrombocytopenia Syndrome is the development of thrombocytopenia resulting from significant exposure to heparin. In the hospital setting, patients are placed at risk when heparin flush is used to keep the line patent opposed to using normal saline flush. *Catheter occlusion limits or prevents blood aspiration, flushing, or the administration of medications. Signs of an occlusion include the inability to aspirate blood, resistance to flushing, sluggish infusion, and inability to flush or infuse fluid. To prevent catheter occlusion, Use the SIS technique (saline, infuse medication, saline) to reduce the risk of precipitates. Flush the catheter with at least 10 ml of normal saline solution after blood withdrawal. Also, consider using positive-pressure valves, which reduce the risk of blood reflux into the catheter tip. *Catheter Related Blood Stream Infections are caused by bacteria contamination and migration down catheter track. Maintain good hand hygiene and use aseptic technique when providing site care and administering medication. Do not cross contaminate when flushing multiple lumens. Keeping end-caps tight at all times. Keeping end caps tight can also help prevent occurrence of air embolism. Catheter Related Blood Stream Infections are common, expensive and potentially fatal .

PREVENTION Avoid cross-contamination of lumens Keep end-caps tight Maintain proper hand hygiene Normal saline instead of heparin Use of a different syringe for each lumen when flushing. Wash hands with soap and lukewarm water for a minimum of 20 seconds. Normal saline instead of heparin to avoid HITS and heparin reactions

ROUTINE CARE & DRESSING CHANGES Initial & Routine 24 hrs post insertion Every seven days Maintain sterile/aseptic technique Surgical mask, non-powdered sterile gloves, sterile dressing change kit Indications for dressing change Soiled, raised, loose, torn, or damp *PICC line dressing changes are sterile. The nurse must wear a mask and sterile gloves to prevent introducing the patient to microorganisms. Turn the patient head away from the site (if necessary, apply a mask on the patient as well). *Maintaining a clean and dry dressing is crucial to continue a well functioning PICC line. Dressings must be changed 24 hours post insertion and then every 7 days minimum. However, if the dressing becomes wet, soiled or loses integrity, it must be changed at that time. PICC line dressings may become wet during bathing or showering. Even the most protected dressing is susceptible to become wet during bathing. Once wet, moisture and body heat become the ideal breeding ground for bacteria. So be sure to assess the dressing site between dressing change days.

MEDICATION INFUSION Clean port Scrub vigorously with an alcohol swab Flush using SIS method 10mL syringe or larger *It is important to maintain aseptic technique when infusing any fluids or medications. Clean the port using a vigorous scrub with alcohol. *Infuse the medication using the SIS method. (saline flush, infuse medication, saline flush) to avoid to the build up of precipitates, which can result in catheter occlusion. *Failure to flush with adequate amount of normal saline can lead to medication occlusion

MAINTAINING PATENCY Assess Patency Upon initial assessment Before administering medications At least every 8 hours Use 0.9% sodium chloride (normal saline) *Evidence has found normal saline flush to be as effective as using a heparin flush. Alongside, using normal saline is more cost effective and has less complications than using a heparin flush. *PICC line patency should be assessed during the initial assessment, before administering medications, and at least every 8 hrs.

DATABASES USED… CINAHL MedLine

QUESTIONS???

Thank you for your time!