Radiology

Care and Maintenance

Dressing Changes

Dressing Change Frequency

Transparent dressings are changed every 7 days.

Dressings containing gauze are changed every 48 hours.

(If StatLock© present, please change with every dressing change)

Gather supplies:

  • Clean gloves
  • Sterile Central line dressing change kit 

OR

  • Sterile gloves
  • Mask (2)
  • 2% Chlorhexidine-70% alcohol applicator
  • Sterile transparent dressing with Chlorhexidine (CHG) or a sterile transparent dressing if chlorhexidine is contraindicated for the patient.
  • Sutureless securement device ("StatLock" ©) as needed for PICC line
  • Alcohol/povidone iodine swabstiks - 3 each, if chlorhexidine is contraindicated for the patient.

 

Preparation of Equipment

  • Perform hand hygiene
  • Inspect all IV equipment and supplies
  • Clean and disinfect the work surface using a facility-approved disinfectant, as needed, to prepare for setting up a sterile field

Steps: 

  1. Obtain assistance of second caregiver if patient cooperation cannot be assured due to age or altered mental status.
  2. Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
  3. Apply clean gloves.
  4. Apply mask to patient or ask patient to turn head away from catheter site.
  5. Apply personal protective equipment (PPE) such as gown and cap per protocol.
  6. Remove dressing and dispose in waste container.
  7. Remove gloves and dispose in waste container.
  8. Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
  9. Apply sterile gloves.
  10. Pinch the wings on the Chlorhexidine-70% alcohol applicator to break the ampule and release the antiseptic onto the sponge pad.
  11. Clean area approximately 2 inches around the catheter exit site with the chlorhexidine applicator. Use a back and forth motion for 30 seconds to clean site.
  12. If using alcohol and povidone iodine, clean in a circular motion from the PICC exit site outwards approximately 2" in diameter.
  13. Allow the area to air dry for 30 seconds.
  14. Secure catheter with Advance CHG Tegaderm and/or sutureless securement device ("Stat-Lock" ©)
  15. Note date, time and initials on dressing.
  16. Document the date and time of the procedure and assessment of the site in the patient's medical record.

 

Flushing the Catheter 

  • No flush is recommended for continuous infusions
  • Variations in practice for a specific population may be guided by unit protocols.
  • All PICC lumens are flushed with 10 ml normal saline
    1. After intermittent IV medications and infusions
    2. After blood draws 
    3. Every 12 hours if lumen is not in use
  • Flush should ensure no visible blood is in cap.
    1. Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
    2. Apply clean gloves. 
    3. Scrub external surface of the cap(s) vigorously with approved antiseptic for 10 times.
      1. isopropyl alcohol 70% 
      2. chlorhexidine gluconate 2%-isopropyl alcohol 70% 
    4. Allow antiseptic to air dry on site.
    5. Always use a 10 cc syringe or larger. Smaller syringes put too much pressure on the PICC line and may cause damage to the catheter.
    6. Flush using the "PUSH-PAUSE" method. Simply push a small amount of saline into catheter, pause, and then push some more in. Repeat this step until total flush is given.
    7. Clamp the PICC before disconnecting the syringe.
    8. Flush all lumens twice a day even when not in use.
    9. Document intervention in patient's medical record.
    10. If resistance is encountered while flushing initiate the declotting protocol utilizing t-PA (Cathflo). 

**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures - Central Venous Catheter Care (Nur-HS 104)

Changing the Injection Cap: Also referred to Needless connector

This is required once every 4 days.

  1. PICC caps are changed every 96 hours or if blood or debris is observed. 
  2. Gather supplies on a clean, stable work surface: 
    1. Chlorhexidine-70% alcohol applicator (1)
    2. Clean gloves
    3. Sterile cap(s)  
    4. Prefilled 10 mL syringe containing normal saline 
    5. Disinfectant end cap containing 70% isopropyl alcohol. Common brand is the 3 M Curos 
    6. Three (3) 70% isopropyl alcohol swabstiks and three (3) 10% povidone iodine swabstiks may be used if patient has Chlorhexidine allergy.
  3. Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 20 seconds.
  4. Apply clean gloves.
  5. Open the cap package while maintaining the sterility of the syringe tip; attach the prefilled syringe containing normal saline to the new cap.
  6. Flush the cap with normal saline solution to purge the cap of air.      Leave the syringe in place.
  7. Close the clamp between the cap and the catheter. 
  8. Remove the existing cap.
  9. Perform a vigorous mechanical scrub of the catheter hub for at least 5 seconds using an antiseptic pad. Allow it to dry completely.
  10. Remove the protective cover from the flushed cap.
  11. Attach the flushed cap to the catheter hub. Rotate to tighten, taking care not to overtighten.
  12. Unclamp the catheter and aspirate slowly for a blood return.
  13. If you obtain a blood return, inject normal saline solution slowly into the catheter.

**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures- Central Venous Catheter Care (Nur-HS 104)

Declotting the Catheter

  • Fibrin accumulation can cause partial or complete blockage of a PICC.  Administration of a thrombolytic agent can be safely given to clear a blockage of the internal lumen of the PICC.
  • Indications:
    1. Partial or complete occlusion of the PICC
    2. Difficulty flushing the PICC
    3. Inability to withdraw 3mls or > of blood from the PICC.
  • Contraindications: If additional symptoms such as swelling of the PICC arm, leaking from the insertion site, or pain along the PICC tract t-PA (Cathflo) should not be administered until ultrasound can be performed to rule out vascular thrombosis.
    1. Midlines terminate in a peripheral vein. Due to the tip location, blood aspiration from a midline may not be possible and not considered a blockage.
    2. If a PICC malposition is suspected, a chest x-ray should be ordered to confirm tip location prior to administration of t-PA (Cathflo).
  • Procedure:
    1. Obtain order for t-PA (Cathflo). See CVC Care Grid for specific dose recommendations.
    2. Gather supplies on a clean, stable work surface:
      1. 2% Chlorhexidine-70% alcohol applicator
      2. Two (2) sterile gauze pads or two (2) alcohol prep pads
      3. Clean gloves.
    3. Perform hand hygiene with hospital approved waterless alcohol gel or foam cleaning solution or, if visibly soiled, wash hands with soap and water for 15 seconds.
    4. Apply clean gloves.
    5. Scrub from the connection between catheter and cap outward in a circular fashion using Chlorhexidine-70% alcohol applicator.
    6. Extend cleansed area approximately 1 inch on either side of the catheter and cap.  
    7. Stop infusions and clamp lumen of the PICC lumen to be declotted.
    8. With alcohol prep pads or sterile gauze wrapped around both sides of the junction, remove the cap from hub.
    9. Attach t-PA (Cathflo) syringe to the hub. 
    10. Unclamp the lumen.
    11. Slowly instill using a gentle push-pull motion on the plunger of the syringe.
    12. Clamp PICC and connect hub to a new primed cap.
    13. Leave t-PA (Cathflo) in place for 120 minutes.
    14. After 120 minutes, unclamp PICC and attempt to aspirate drug and 5ml of blood.
    15. If successful, irrigate CVC with 10 mls of normal saline. Replace cap(s) or tubing to resume IV.
    16. If unable to aspirate, clamp PICC and wait another 30-60 minutes. 
    17. If unsuccessful, consult with MD/designee re: order for repeat administration of t-PA

 

**For UCLA staff, please refer to UCLA Department of Nursing Policies and Procedures-Central Line Care  (Nur-HS 104)

 

Pre-existing PICC

  • Please take the following steps for patients who present to the UCLA Health System with an existing PICC line:
    1. Contact the medical team to order a portable chest x-ray order to confirm catheter tip placement.
    2. Perform a sterile dressing change if due or the dressing is not secure.
    3. Note the length of catheter external to the body in the LDA flowsheet.
    4. Do not use the line until a physician has provided an order "OK to use PICC" or "OK to use MIDLINE".

PICC Removal

  • To remove PICC lines within the UCLA Hospital System you need to exhibit competency. 
  • Cornerstone has Adult and Pediatric PICC removal training modules.  These should be completed as part of the Competency training. 
  • Once PICC removal proficiency is achieved, your Unit Manager / Educator can document competency. 
  • Competency is reviewed on an annual basis.