PICC And Midline Catheters
PICC and Midline Catheters
Infusion RN’s Deb Bucher RN BSN CRNIDawn Finch RN CRNIMarianne Hansen RN BSN CRNIKarman Youngblood RN BS CRNI
Infusion Pharmacist Kathy Cimakasky Pharm D Tamara Migut RPh
Intravenous Decision TreeNo needfor IVaccess.NoDoes patient needIV access?YesIs therapyappropriate forperipheral infusion?Obtain MD orderfor CIS consultfor central linePICC vs. ChestNoYesDoes patient havehistory of difficult IVstart and/or doestherapy consist ofmultiple blood draws?Obtain MDorder for CISconsult formidline/PICCplacement.YesNoIs therapy plannedfor greater than 3days?Is therapygreater than 3days but lessthan 4 weeks?YesNoNoIs therapygreater than 4weeks?YesYesPlaceperipheral IV.Obtain MD orderfor CIS consultfor midline.Obtain MDorder for CISconsult forcentral linePICC vs. Chest.
What is a PICC Peripherally Inserted Central Catheter Indications for PICC TPN or other solutions requiring centralplacement such as certain chemotherapies. Therapies that over time can cause chemicalphlebitis such as Vancomycin and Nafcillin Therapies lasting longer than 4 weeks Can be used for blood draws
What is a Midline Peripherally inserted catheter that tip is notcentrally placed, such as a Groshong May remain in for 30 days Determine by measurement of line or CXR Indications for use: poor venous accessrequiring multiple IV site changes andtherapies lasting less than 30 days May use for lab draws
What is an Implantable Port A port (often referred to by brand names such asMediPort) is a central venous line that does nothave an external connector; instead, it has a smallreservoir implanted under the skin. Medication is administered intermittently byplacing a small needle through the skin into thereservoir. Ports are used for patients needing long-termintermittent treatment.
PICC and Midline Flushing Sodium Chloride- 5cc before and afterroutine IV/medications 10cc NS before and after blood draws(PICC only-10cc Sodium Chloride b/aTPN) 20cc NS after blood product administration Heparin 100 units/cc 2.5cc final flush inabsence of continuous infusion and dailywhen line not in use .
Sterile Dressing Change Change dressing 24 hours post insertionEvery 7 daysHibiclens followed by ChloraprepBiopatch – an antimicrobial dressingSteri-strips to secure siteClear bio-occlusive dressingChange cap every 7 days or wheneverremoved
Hibiclens scrub
Chloraprep swab to remove soap
Biopatch around line at insertionsite
Biopatch over line at insertionsite
Steristrips from insertion site tohub
Bio-occlusive dressing to cover
Secured with K-lok overextension tubing
PICC Secured with Statlock
Line Repair Clean site with Hibiclens and ChloraprepClean segment of line to be trimmedTrim line above damaged portionSlide sleeve over lineGrasp emerging line with sterile glovedfingers Insert stylet tip fully into line and slidesleeve up to connect firmly
Line repair continued Single lumen Groshong lines will clickwhen securely fastened. Dual lumen Groshong lines will have whitestylet to remove after repair complete. After repair complete tug gently to ensuresecure connection Apply sterile dressing and flush line
Hibiclens scrub (be sure to cleanarea of line to be cut)
Chloraprep swab (be sure to preparea of line to be cut)
Cut line above damaged portion
Slide sleeve over cut line
Grasp emerging end to preventinternal migration
Insert stylet into line up to hub
Stylet fully inserted up to hub
Slide sleeve up; align grooveswith the wings and click together
Add extension and cap torepaired PICC; flush and dress
Lines that cannot be repaired Dual lumen lines that are broken above thewhite y Lines that are clear and have clampsattached to the line.
De-clotting Line Mix solution according to pharmacydirections Withdraw appropriate volume of solutioninto syringe Remove injection cap, attach syringe withde-clotting agent to hub of occluded lumen Inject de-clotting solution. (this may or maynot infuse easily
De-clotting line continued If it is difficult to instill de-clotting use agentle push/pull action of the syringe toallow gradual mixing. TO PREVENTRUPTURE DO NOT FORCE. Remove or tape syringe down to arm and letde-clotting solution work for 30-60 minutes
De-clotting PICC continued Attempt to aspirated after 30-60 minutes If blood cannot be aspirated, try to aspirateagain in 15 minutes. If blood aspiration success Aspirate 5cc of blood and discard Irrigate catheter with 10cc Sodium Chloridefollowed by 2.5cc Heparin 100units/cc
Mix medication according todirections and draw into syringe
Attach syringe to hub and instillmedication
De-clotting line waiting 30-60min
Attempt to aspirate and withdraw4-5cc of blood to waste
Flush line with NS 10cc followedby Heparin 100u/cc 2.5cc
Migration Movement of catheter from its originalplacement. To prevent further migration, line should beadequately secured with securing deviceand occlusive dressing. Repairable lines should be trimmed ofexcessive exterior length and repaired. Assessment needs to be completed todetermine if placement remains adequatefor current IV therapy.
PICC migrated outward severalinches
Measure migrated line
Phlebitis Phlebitis shall be defined as aninflammation of the vein and is a potentialcomplication It will be rated according to a scale of 0through 4
Phlebitis Scale0 No clinical symptoms
Phlebitis Scale1 Erythema with or without painEdema may or may not be present.No streak formationNo palpable venous cordMoist heat may be applied if there is painPatient may be asked to use the arm
Phlebitis Scale2 Erythema with or without painEdema may or may not be presentStreak formationNo palpable venous cordLow heat for 2-3 days, elevate arm, mildexercise and follow up daily to see ifdecrease in symptoms
Phlebitis Scale3 Erythema with or without pain.Edema may or may not be present.Streak formation.Palpable cord.Daily visual monitoring for any decrease insymptoms
Phlebitis ScaleGrade 4 Erythema with or without painEdema may or may not be presentStreak formationPalpable venous cord greater than 1 inch in lengthPurulent drainageCulture site, cleanse site, notify M.D., bloodcultures, may remove catheter and culture tip
PICC line removal Gather suppliesRemove dressingGently retract line from armApply pressure to siteCover with gauze and apply occlusivedressing
Removing PICC line
Gently pull line out
Apply pressure with gauze whenline removed
PICC line removed, dressingapplied
Final measurement of removedPICC line
Questions RN is available on call 24 hours /day For questions call 383-3099 Adapted with permission from the Carle InfusionDepartment
20cc NS after blood product administration Heparin 100 units/cc 2.5cc final flush in absence of continuous infusion and daily when line not in use . Sterile Dressing Change Change dressing 24 hours post insertion Every 7 days Hibiclens followed by Chloraprep
SAMPLE POLICY & PROCEDURE DRAFT 10/16/06 Legal Issues: PICC Line and Midline Program Outline: 1. State regulations regarding PICC Line or Midline placement 2. Nursing qualifications to place a PICC Line or Midline 3. Nursing competency 4. Policies and Procedures for PICC Lines and Midlines 5. Patient consent for PICC Line or Midline placement
Mar 12, 2018 · prior to each PICC access. 3. Aspirate the PICC for a positive blood return. 4. Prior to each Luer attachment, repeat the scrub of the needleless connector, and allow it to dry. 5. Flush with preservative-free 0.9% sodium chloride to clear the catheter of all blood residues. 6. Repeat the scrub of the needleless connector, and allow it to dry. 7.File Size: 1MBPage Count: 20Explore furtheriCare PICC Guideline - Queensland Healthwww.health.qld.gov.auHow to Measure a PICC Line With Dressing Changehealth-faq.commeasurement of PICC external length / arm circumference .iv-therapy.netTurbo-Ject Power-Injectable PICC Cook Medicalwww.cookmedical.comNursing Management of Venous Access Devices: Peripherally .www.mghpcs.orgRecommended to you b
Taking Care of the PICC It is important to take care of your PICC properly, to avoid infection. Infection can happen when germs enter the blood through the: Puncture site while the PICC is being inserted Infusion line at the point the PICC enters the skin Caps at the end of the PICC
power injectable PICC (Teleflex Medical, Wayne, PA); 5) 4F single-lumen polyurethane power injectable PICC (Pro-PICC; MedComp and Health Line, San Francisco, CA); 6) 4F single-lumen polyurethane power injectable PICC (Bard Access Systems, Salt Lake City, UT). Indications for PICC use in our hospital were: 1) Need to preserve
6 PICC insertion procedure 9 . Peripherally Inserted Central Catheter (PICC) & Midline . Practitioners will complete consent training in line with Aintree’s Policy. The use of an ultrasound
PICC or Midline Catheter Sterile Dressing Change If parts of the gel come off the dressing, remove the gel with a sterile saline soaked gauze. Hold the catheter at the exit site with the other gloved hand to keep it from being pulled out when removing the dressing. Always check the length of the PICC catheter from where it exits your skin to its tip with each dressing change.File Size: 614KBPage Count: 9
Policies and Procedures: Central Venous Catheters – PICC, Short Term, Tunneled, I.D. #1042 Implanted - Blood Withdrawal Page 2 of 10 Peripherally Inserted Central Catheter (PICC): A central venous access device inserted into a peripheral vein whose tip dwells in the superior vena cav
-Solo - valve at proximal hub - Power PICC Angio Dynamic (Navilyst) - Vaxcel -Xcela (Power PICC) - Bioflo (Power PICC) & endexo All 3 of these are valved at the proximal hub – PASV . Multi-lumen PICCs should not have one port left occluded. Valved PICCs have a lower incidence of infection due to
