How to dress a PICC line? A step-by-step sterile guide

According to the Association for Professionals in Infection Control and Epidemiology (APIC), proper care of a Peripherally Inserted Central Catheter (PICC) is crucial for preventing infection. This guide will explain exactly how to dress a PICC line using sterile technique, detailing each step to ensure safety and cleanliness throughout the process.

Quick Summary

A sterile dressing change is required for proper PICC line care, typically performed weekly or if the existing dressing becomes wet, soiled, or loose. The procedure involves meticulous hand hygiene, preparing sterile supplies, cleaning the insertion site with an antiseptic, and carefully applying a new dressing to secure the line and protect against infection.

Key Points

• Maintain Strict Sterility: Proper hand washing, using sterile gloves, and handling only sterile supplies are non-negotiable for preventing dangerous infections.

• Gather All Supplies First: Have your entire sterile kit and a clean work area prepared before starting to ensure the process is seamless and sterile.

• Inspect the Site Thoroughly: During each dressing change, carefully check the insertion site for any signs of infection, such as redness, swelling, warmth, or drainage.

• Allow Antiseptic to Dry: After cleaning the site with chlorhexidine or other prescribed solution, let it air dry completely before applying the new dressing to maximize its effectiveness.

• Secure the Line Firmly: Ensure the catheter and dressing are properly secured to prevent accidental dislodgement, which is a common cause of complications.

• Document the Date and Time: Always label the new dressing with the date and time of the change to know when the next dressing change is due.

Understanding the Importance of a Sterile Dressing Change

A Peripherally Inserted Central Catheter (PICC) is a valuable medical tool for long-term treatments like intravenous medication, nutrition, and blood draws. However, the insertion site creates a potential pathway for bacteria to enter the bloodstream, which can lead to a serious bloodstream infection. The dressing's primary purpose is to act as a sterile barrier, protecting the site from germs and external contamination. Adhering strictly to sterile technique is paramount to patient safety and the successful use of the PICC line.

Gathering Your Sterile Supplies

Before you begin, gather all necessary supplies on a clean, stable surface away from any drafts. It's often helpful to use a commercially prepared sterile dressing kit provided by your healthcare provider. Your typical kit will contain:

• Face masks: One for the person changing the dressing, and one for the patient.
• Sterile gloves: A pair for removing the old dressing and a separate, sterile pair for applying the new one.
• Non-sterile gloves: For handling the initial items.
• Antiseptic solution: Typically a chlorhexidine gluconate (CHG) swabstick or applicator. Povidone-iodine may be used if there is a CHG allergy.
• Skin protectant wipes: Applied to the skin where the new dressing's adhesive will sit.
• Transparent dressing: A clear, sterile, semipermeable dressing (e.g., Tegaderm™) that allows for inspection of the site.
• Stabilization device: If required, such as a StatLock® or SecurAcath®.
• Sterile Biopatch: A foam disc with an antimicrobial agent, placed around the catheter at the insertion site.
• Adhesive remover wipes: Optional, to aid in removing the old dressing.
• Trash bag: A small, disposable bag from the kit to collect waste.

Step-by-Step Procedure for a PICC Line Dressing Change

Step 1: Preparation and Hand Hygiene

1. Wash your hands thoroughly with soap and water for at least 20 seconds.
2. Put on your non-sterile gloves and a face mask. The patient should also wear a mask and turn their head away from the insertion site during the procedure to prevent breathing on the sterile field.
3. Open the sterile dressing kit and prepare your supplies on the clean, flat surface, using the outer packaging as a trash receptacle.

Step 2: Removing the Old Dressing

1. Gently and slowly peel off the old dressing, pulling it towards the insertion site to avoid dislodging the catheter.
2. Use adhesive remover wipes as needed, but be careful not to touch the insertion site itself.
3. Inspect the old dressing and Biopatch for any excessive drainage, blood, or signs of infection.
4. Remove and dispose of your non-sterile gloves, the old dressing, and any waste. Wash your hands again thoroughly.

Step 3: Assessing the Site and Applying Sterile Gloves

1. Visually inspect the insertion site for any redness, swelling, pus, or unusual warmth. Look for any change in the external length of the catheter.
2. Palpate the area above the insertion site for tenderness or swelling, which could indicate complications like phlebitis or thrombosis.
3. If any signs of infection are present, do not proceed. Cover the site with sterile gauze and contact the healthcare provider immediately.
4. Open the inner sterile packaging of your dressing kit and put on the new pair of sterile gloves, being careful not to touch anything non-sterile.

Step 4: Cleaning the Site

1. Use the chlorhexidine applicator to clean the area. Scrub vigorously with a back-and-forth motion for at least 30 seconds, covering the entire area where the new dressing will be.
2. Clean the outside of the catheter tubing, moving from the insertion site towards the hub.
3. Allow the antiseptic to air dry completely for at least 30 seconds. Do not blot or fan the area.
4. Use a skin protectant wipe on the area where the adhesive will stick, avoiding the actual insertion site.

Step 5: Applying the New Dressing

1. If using a Biopatch: Position the Biopatch around the catheter so the antimicrobial-impregnated side is touching the skin.
2. Apply the stabilization device: Secure the StatLock or other device according to its instructions. Ensure the catheter is properly seated in the locking mechanism.
3. Apply the transparent dressing: Remove the backing from the transparent dressing and place it over the insertion site, Biopatch, and securement device. Do not stretch the dressing. Smooth it down firmly from the center outwards to seal all edges.

Step 6: Securing and Documenting

1. Apply any additional tape to reinforce the dressing and secure the tubing, if necessary. Loop the tubing if instructed to prevent kinking.
2. Remove your sterile gloves and dispose of all used materials in the trash.
3. Write your initials, the date, and the time on the provided dressing label. This is a critical step for tracking changes and ensuring timely replacement.

Comparison of PICC Line Dressing Types

Dressing Type	Benefits	Drawbacks
Transparent Film	Allows for continuous visual inspection of the site; moisture barrier; breathable; patient comfort.	Can be less effective on heavily diaphoretic or draining sites; may not be suitable for patients with skin allergies.
Gauze Dressing	Good for heavily draining sites or sensitive skin; can be secured with medical tape.	Requires more frequent changes (typically every 48 hours); prevents visual inspection of the site without removal.
Antimicrobial-Impregnated	Releases antiseptic (e.g., CHG) to actively inhibit microbial growth; often used for high-risk patients.	Can cause skin irritation or allergic reactions in some patients; more expensive than standard dressings.

For more information on infection prevention guidelines, you can consult the Centers for Disease Control and Prevention website.

Conclusion

Mastering how to dress a PICC line is an essential skill for patients and caregivers to reduce the risk of infection and ensure safe, effective treatment. By following a strict sterile procedure—from hand hygiene and site assessment to meticulous cleaning and securing the new dressing—you can confidently manage your PICC line at home. If you encounter any complications, always contact your healthcare provider for guidance. Your diligence in maintaining a sterile dressing is a vital step toward a successful recovery.

Frequently Asked Questions

How often should I change my PICC line dressing?

PICC line dressings should typically be changed once a week. However, you must change it sooner if it becomes wet, dirty, loose, or if there is excessive drainage from the insertion site.

What should I do if my PICC dressing gets wet?

If your PICC dressing gets wet, it must be changed immediately to prevent bacteria from entering the insertion site. Gather your sterile supplies and follow the proper procedure for a dressing change. Use a waterproof cover, like a commercial sleeve, when showering to prevent this.

Can I go swimming with a PICC line?

No, you should never swim with a PICC line. Full immersion in water, such as in a pool, hot tub, or bathtub, can introduce bacteria to the insertion site and significantly increase the risk of infection.

What are the signs of a PICC line infection?

Key signs of infection include redness, swelling, tenderness, warmth, or pus at the insertion site. You may also experience a fever, chills, or general malaise. Contact your healthcare provider immediately if you notice any of these symptoms.

What kind of dressing materials do I need?

You will need a sterile dressing change kit, which your healthcare provider will prescribe. It typically contains a transparent dressing, antiseptic wipes (like CHG), a securement device, a Biopatch, sterile gloves, and masks.

Is it safe to change the PICC dressing myself?

While it is possible, it is often recommended to have a trained caregiver assist, especially since the procedure requires two hands and strict sterile technique. Your healthcare team will provide specific training for your situation.

What if the PICC line accidentally comes out?

If the PICC line is accidentally pulled out, do not panic. Apply firm pressure to the insertion site with a sterile gauze pad and seek immediate medical help. Never attempt to reinsert the line yourself.