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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Pediatrics, Parenting

Caring for your Child’s PICC (7595)

Caring for your Child’s PICC (7595) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pediatrics, Parenting

7595



Caring for your Child’s PICC

Your child is going to have a Peripherally
Inserted Central Catheter (PICC) inserted
into a vein in the arm. This handout is to
teach you about getting ready for placement
and care of the PICC. If you have any
questions or concerns, please feel free to ask
your child’s doctor or nurse.

What is a PICC?

A PICC is a flexible hollow tube placed in a
vein in the arm, most often above the
elbow. The PICC is about 18 to 24 inches
long and extends into the large vein towards
the heart. A PICC can be left in for a longer
period of time than a peripheral catheter
(IV). There are one, two, or three lumens at
the end of the PICC where medicine and
fluids can be given and labs can be drawn.

The PICC can be secured in place by two
different devices. One device is called a
Statlock® and the other is called a
SecuraCath®. When planning to place your
child’s PICC, the team will discuss the two
devices with you. A Statlock® is a device
that clips around the catheter and sticks to
the arm with adhesive. The Statlock® is
changed with every dressing change.
SecuraCath® is a device that is placed under
the skin to secure the line in a different way.
This device stays in place for as long as the
PICC stays in and can be easily lifted to be
cleaned during dressing changes.

Who decides if or when a PICC is
needed?

Your child's doctor will decide if a PICC is
needed based on the therapy your child
needs. A PICC is often used for children
who need long term antibiotics,
chemotherapy, fluid or Total Parenteral
Nutrition (TPN) given at home.

What are the benefits of a PICC?

ξ Comfort: When your child has a
PICC, it takes away the need to
be stuck for frequent IV
changes or most lab draws.
ξ Independence: The PICC may
allow your child be treated at
home instead of the hospital.

What is the process?

After the doctor decides that a PICC is the
best course of therapy for your child, a child
life specialist may come to your child’s
room to talk with you and your child about
getting a PICC. This specialist will also
work with you and your child to decide a
developmentally appropriate distraction
method. At this time, parents should also
think about if they would like to be present
with their child for the procedure. Then, a
PICC team nurse comes to your child’s
room. This nurse is specially trained in
placing PICC lines. The nurse will look at
your child's arm and decide on one or two
veins that will work best.

How can I best comfort my child?

There is some discomfort having a PICC
placed, similar to an IV placement. Even
though the catheter sits in the vein near the
heart, your child should not have any chest
pain. Distraction methods such as listening
to music, singing, breathing exercises, and
watching TV may also be helpful.

Will my child be asleep?

With the help of numbing and relaxing
medicines, and preparation from the child
life specialist, most children do not need
sedation. Small children may need to be
sedated. After the child life specialist,


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nurse, and doctor talk with you and your
child, the best choice is made based on the
situation. If it is decided that sedation is the
best option for your child, the doctor will go
over the risks and benefits and types of
sedation.

Can you explain the procedure for
placing a PICC?

Just to remind you, every situation will be a
little different. Not all children want to use
topical creams and not all children need
medicine to help them stay calm. Your
child is evaluated and a personalized plan is
created. Below is one example of what
might happen:

If needed, about 30 minutes before the PICC
is placed the nurse may have your child take
an oral medicine called midazolam for
relaxation. Other methods of pain relief and
distraction include I Spy books, iPad games,
and stress balls.

The person placing the PICC sets up while a
child life specialist or another member of
our staff distracts your child. The nurse
cleans your child's arm with antiseptic soap
and puts drapes over the area. PICC
placement is a sterile procedure, so it is very
important that your child does not touch the
area where the nurse is working. You and
your child will be asked to wear masks in
the room.

After everything is set up, a small needle is
used to guide the soft catheter into the vein.
A small camera is used to see the vein.
Once the nurse is sure that the PICC is in the
vein, the needle is removed, leaving only the
soft catheter behind. A dressing is placed
and an x-ray is taken of your child's arm to
ensure that it is in the right spot before use.

How Do I Care For and Change the
Dressing?

While your child is in the hospital, a nurse
changes the dressing every 7 days or more
often if the dressing becomes wet, soiled, or
loose. A friend or family member may be
taught how to change the dressing at home
as well. At home the dressing will also be
changed every 7 days. Your child most
likely will be sent home with a transparent
dressing, BioPatch® and securement device.
There is the possibility your child will be
sent home with a different type of dressing
called a 3M CHG dressing. If the 3M CHG
dressing, transparent dressing, StatLock®
device, or BioPatch® becomes loose, wet, or
soiled, the whole dressing must be changed.
If the 3M CHG dressing needs to be
changed, the dressing will be replaced with
the transparent dressing, BioPatch®.

Supplies: Central Line dressing kits contain
these items except where noted.
ξ Exam gloves (not included in
central line kit)
ξ Sterile gloves
ξ Masks
ξ Alcohol swab sticks
ξ ChloraPrep® skin antiseptic
ξ Skin prep
ξ StatLock® PICC Plus (not
included in central line kit)
ξ BioPatch® (may need to be added
based on which kit you get from
your home infusion agency)
ξ Transparent dressing

How to change the sterile dressing
1. Gather all supplies.
2. Wash your hands well with soap
and water for 30 seconds. Dry your
hands. Apply exam gloves and
place a mask on yourself and the
child.
3. Take off the dressing by rolling the
corners of the dressing furthest from
the insertion site and pull outward
lifting the transparent dressing up
off the skin. Use alcohol pads or
swabs to help loosen the dressing.
Use a similar technique for the 3M
CHG Dressing, by removing from
the edge towards the insertion site


3
of the PICC. If the CHG pad is
sticking, use an alcohol pad or a few
drops of 10 mL Normal Saline 0.9%
syringe on the CHG pad.
4. Use an alcohol pad to separate the
dressing from the BioPatch® to
avoid pulling the catheter out.
Remove the transparent dressing
and BioPatch®. Be sure to secure
the catheter.
5. Look at the insertion site for
redness, swelling, or drainage.
Check to see if the catheter has
moved out of the skin. If it has
slipped out more than an inch call
your home care nurse or medical
provider. Never try to slip the
catheter back in the vein, because it
may give you an infection or kink
your catheter.
6. To remove the StatLock®, follow
these steps.
a. Stabilize the catheter by
placing a gloved finger over
the transparent dressing at
insertion site.
b. Stabilize one side of the
StatLock® doors with the
thumb of the same hand
pushing on the catheter.
c. Open the opposite door using
the overhang on the bottom
of the door (not the center).
d. Switch hands and repeat.
e. Gently remove the catheter
from the StatLock®.
f. Using alcohol, soak an edge
of the StatLock® until a
corner is lifted. Allow the
alcohol to seep under the pad
and dissolve the adhesive.
Do not force or pull the pad
off, let the alcohol do the
work to dissolve the
adhesive.
7. If using a SecuraCath® device, do
not remove the device with dressing
changes. Simply clean the
SecuraCath® device with
chlorhexidine on top and bottom of
the device. The device can be lifted
off the skin to clean but do not twist
or rotate the device.
8. Take off your exam gloves and
wash and dry your hands. While
doing this remember to never turn
your back to your child.
9. Open sterile supplies, including
StatLock® kit (if necessary) and put
on sterile gloves.
10. Remove dried blood or debris with
alcohol wipes or swabs.
11. Activate the ChloraPrep applicator
to release the liquid into the sponge
pad. Please note that your home kits
contain 3 swabs. Do not touch the
pad/swab. Gently press the
sponge/swab against the skin near
the catheter PICC site until you can
see the liquid on the skin. Use a
back-and-forth friction rub for 60
seconds to all skin and catheter
areas being covered by the dressing.
Take care to clean the catheter and
wings on both sides. While doing
this remember to keep at least one
glove sterile. Let air dry for at least
30 seconds. Do not blot, wave at, or
blow-dry the area.
12. Apply skin protectant where the
StatLock® anchor and transparent
dressing will touch the skin. Allow
to dry.
13. Place the BioPatch® dressing around
the catheter site – blue, grid side up;
foam side down on skin. The slit in
the BioPatch® should be placed in
line with the PICC.
14. Loosen doors of the StatLock® by
opening and closing them once.
Make sure the paper backing is not
stuck to back of the StatLock®.
15. Place catheter wing securement
holes over posts of the StatLock®
and close plastic doors one at a


4
time. Do not press on the patient.
16. Place anchor pad over prepped
securement site. Peel away paper
liner, one side at a time, pressing the
pad in place.
17. Apply sterile transparent dressing
over site.
18. Apply dressing change label to
indicate when the dressing is to be
changed.


Example of Correctly Dressed PICC Site



How Do I Flush the PICC?

Your child’s PICC should be flushed and
checked for blood return every day. If you
are not going to give medicines at home,
you will check for blood return and flush
your child’s line with heparin once every 24
hours. If your child needs medicine given at
home then you should use the SASH method
(Saline, Administer medication, Saline,
Heparin). Your nurse may tell you to flush
the PICC more often if needed.

Supplies
ξ 10 mL Normal Saline 0.9%
Flushes
ξ Needleless (MicroClave® Clear)
connector
ξ Sharps® container
ξ 5 mL Heparin Flush




1. Clean the top of the needleless
(MicroClave® Clear) connector with an
alcohol wipe using a “juicing” method
for 15 seconds. Allow to dry for 15
seconds while holding the needleless
connector, and not allowing anything to
touch the top of the connector until
attaching the flush syringe. If anything
touches the top of the connector before
attaching the flush syringe, stop and
repeat this entire step before proceeding
to step 2.








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2. Connect the flush syringe to the end of
the connector. Make sure that the
clamp on the line is open.
3. Push gently and steadily on the plunger
using a push-stop-push method,
clamping the catheter after you
complete the flushing. Note: The PICC
should flush easily. If you find it is
hard to push the fluid in, check to make
sure the clamp is open and that the
catheter is not kinked. If it is still hard
to push the fluid in, do not force the
plunger. Call your child’s home care
nurse or doctor.
4. Remove the syringe and discard it in
the sharps container. At home, you
may double bag syringes without
needles.

How Do I Change the Needleless
Connector?

The needleless connector on your child’s
PICC is changed using a sterile technique
every three days while in the hospital. At
home, the needleless connector can be
changed once a week if your child is not
immune compromised. If your PICC is used
for blood draws, it needs to be flushed with
10 ml normal saline after each blood draw
using a push-stop-push method. After
flushing, if you can see blood in the
needleless connector, remove the connector
and replace with a new one.

Supplies
ξ 10 mL Normal Saline 0.9%
Flushes
ξ Needleless (MicroClave® Clear)
connector
ξ Alcohol Wipe
ξ Sharps® container
ξ Gloves

1. Wash your hands and apply gloves.
Remove the plastic cover from the saline
syringe. Push the air out of the syringe.
2. Connect the syringe filled with saline to
the end of the new needleless
connector. Twist on completely. Push a
small amount of saline into the needleless
connector to ensure there is no air
present. If the tip of the syringe or the
new needleless connector touches
anything other than the end of the
catheter, stop, and replace the syringe.
3. Take the alcohol wipe and clean the
connection between the end (bottom) of
the old needleless connector and the
PICC. Clean for 15 seconds using a
twisting method and let dry for 15
seconds.
4. Remove the blue plastic end from the
needleless connector. While keeping the
PICC clamped, remove the old needleless
needleless connector and twist on the new
one.
5. Unclamp your catheter.
6. Push gently and steadily on the saline
syringe plunger using a push-stop-push
method, clamping the catheter as you
complete the flushing. Note: The PICC
should flush easily. If you find it is hard
to push the fluid in, check to make sure
the clamp is open and that the catheter is
not kinked. If it is still hard to push
the fluid in, do not force the plunger.
Call your child’s home care nurse or
doctor.
7. Remove the syringe. Discard the syringe
in the sharps container. At home, you
may double bag syringes without needles.

Things to remember when you have a
PICC
ξ Avoid having your child’s blood
pressure taken on the arm with
the PICC.
ξ Close the clamp when catheter is
not in use.
ξ Do not re-use any products
including syringes, caps, devices,
etc.
ξ Call your child’s home care
nurse or medical provider if your
child has a fever of 100.4º F or
38º C or greater.
ξ Call your child’s home care
nurse or medical provider if you
notice swelling, redness,


6
drainage, or pain at the catheter
insertion site or anywhere up the
arm.
ξ Wrap your child’s arm in plastic
wrap to cover the line and keep
the needleless connector and exit
site from getting wet for showers.
Glad® Press and Seal works well.
Be sure to change the dressing or
the connector if you feel it got
wet in the shower.
ξ Change the dressing, Biopatch,
and StatLock® device any time it
gets wet, loose, or soiled.
ξ The PICC may be used for most
blood draws.
ξ Do not use scissors near the
PICC or to remove the dressing.
ξ If your child is on a pump, put
the tubing under clothing so it
does not get caught on furniture.
ξ If the PICC breaks, put a belt or
tourniquet snugly on your child’s
upper arm near the shoulder and
go to the closest emergency
room. Your child’s infusion
company may give you an A-
clamp.
ξ Problems, though rare, do occur.
If you have any questions about
your child’s PICC, please contact
your child’s doctor or home care
nurse or medical provider.


Nurse: ________________________________________________________
Doctor: _____________________________________________________
Phone: _______________________________________________________
Name of Home Care Company: ___________________________________________
Home Care Company Phone Number: ______________________________________
Date Catheter Inserted: __________________________________________________
Catheter Brand: ________________________________________________________
Catheter Lot Number: ___________________________________________________
Catheter Fr/Gauge: ______________________________________________________
Trimmed Catheter Length: ________________________________________________
Date of Last Dressing Change: _____________________________________________















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Summary for Home Care


What

If no Medicines infuse
through PICC

If medicines will infuse
through PICC

Dressing change

Every 7 days and anytime the
dressing or BioPatch dressing
becomes wet, loose or soiled.
Every 2 days if a gauze
dressing is used.

Every 7 days and anytime the
dressing becomes wet, loose
or soiled. Every 2 days if a
gauze dressing is used.


Flush

Check for blood return and
flush every 24 hours.

Use SASH method with each
medicine.
Saline
Administer medicine
Saline
Heparin


Change needleless
(MicroClave® Clear)
connector

Every 7 days if not
immunocompromised.
Every 3 days
Every 7 days if not
immunocompromised.
Every 3 days
Accessing the needleless
MicroClave® Clear connector
Clean the top of the needleless
connector with alcohol wipe
using a “juicing” method for
15 seconds and allow to dry
for 15 seconds.
Clean the top of the needleless
connector with alcohol wipe
using a “juicing” method for
15 seconds and allow to dry
for 15 seconds.















Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 10/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#7595.