1. PICC Line Care and Maintenance Preview…….just a taste of what we can offer you and your facility! Vascular Access Plus (402) 449-9330 info@vascularaccessplus.com

2. PICC Line Care and Maintenance Vascular Access Plus Jamie L. Hamm RN, BSN Vascular Access Specialist

3. Learning Objectives Verbalize and Demonstrate how to change a PICC line dressing Verbalize and Demonstrate how to change a needleless injection cap Verbalize and Demonstrate how to scrub the hub Verbalize and demonstrate how to perform PICC line measurements Verbalize and Demonstrate how to document PICC line care Verbalize and Demonstrate how to assess your patient’s PICC line

4. Vascular Access Review What is a PICC line? Who can change a PICC line dressing and needleless injection cap in my facility? Who can perform a PICC line assessment in my facility? Who does the documentation? How is a central line different than a PICC line? What do these initials stand for? – INS – ONS – JACHO – ENOA – AVA – VAP

5. PICC line Dressing Change ASSESS THE PATIENT Does my patient still need the PICC line? What are the previous measurements for my patient? Do I have an insertion record? Do I need two nurses to change the PICC dressing? GATHER SUPPLIES Central Line dressing change kit with CHG, mask, and sterile gloves Securement device (StatLock or Shield) Non-sterile gloves Antibacterial hand gel or soap and water Tape Measure BioPatch

6. SHIELD

7. Now you are ready to change the dressing at the patient’s bedside… 1. Set up your sterile field and position your patient’s arm. Use a piece of tape to hold the PICC in place on the arm if needed. 2. Wash your hands and put on non-sterile gloves and remove old dressing and discard gloves. Re-wash your hands. 3. Put on sterile gloves. Use CHG and cleanse the patient’s skin with FRICTION for a minimum of 30 seconds. DON’T FORGET TO WASH UNDER THE PICC LINE AND AN EXTENDED AREA 3+ INCHES AROUND). Let Air Dry. You Can keep one hand sterile and one hand non-sterile OR You can use gauze to maintain sterility of both hands during cleaning 4. Place the BioPatch on if available. 5. Place Shield dressing or StatLock for securement. Cover all the PICC line past the junction and securement of the hub.

8. Where is the hub?

9. “SCRUB THE HUB” There are 2 Hubs… Where is the 2 nd Hub to Scrub?

10. “SCRUB THE HUB”

11. What are the parts of a PICC line measurement? 1. Total Length of the PICC line on insertion You need the insertion record 2. External Length sticking out of patient Done Daily and prn 3. Arm circumference 3 inches above the insertion site and arm circumference is measured in cm around the arm Done Daily and prn

12. External Length Between each dot = 1cm (use your fingertip) This is the Junction. Your external measurement starts here.

13. Total Catheter Length The total length of a Power PICC solo catheter is 55cm total You need to know the total catheter length before removing your patient’s PICC line…….how do you know you got it all out? Note how the PICC line starts with 0 instead of 1

14. Troubleshooting 101 If you do not have a blood return then you have a non-functioning vascular access device…STOP and call Vascular Access Plus for troubleshooting guidance at (402) 449-9330

15. Does my patient still require a PICC line? How many days are left to complete the infusion therapy? Are we just keeping the PICC line to have IV access? Was the PICC line difficult to place? Did the physician want the PICC line removed when therapy ended? Are there signs of infection at the insertion site? Does my patient have a non-functioning access?

16. Should my patient have a PICC line? CDC 2011 recommends a Midline or PICC line for any infusion therapy duration >6 days If your patient requires more than 3 peripheral IV starts for the IV therapy, you will cost your facility/patient as much as putting in PICC line. What type if infusion therapy is ordered? INS recommends a PICC line for any drug with a pH <5 or greater than 9. Have I attempted peripheral IV access prior to requesting a PICC line? Should I attempt peripheral IV access before I call the PICC nurse?

17. There is sooooooo much more! Call Today and book your educational CEU event for your staff! (402) 449-9330