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Site Care and Dressing Change for Central Venous Catheters - PICC and Tunneled Lines (102.008)

Site Care and Dressing Change for Central Venous Catheters - PICC and Tunneled Lines (102.008) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Central Lines

102.008

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: SITE CARE & DRESSING CHANGE FOR CENTRAL VENOUS CATHETERS
-PICC and Tunneled Lines-

Effective Date: January, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed Feb., 2008 May, 2009 March 2012


PURPOSE: To provide guidelines for site care and dressing changes of central venous catheters in adult or
pediatric patients using appropriate infection control measures to prevent intravascular catheter-related
complications at UWMF & DFM Clinics.

DEFINITION:
Central venous catheters are used to give long-term medical treatment for pain, infection, or cancer, or to supply
nutrition. A central venous catheter can be left in place far longer than a peripheral intravenous catheter (PIV), which
gives medication into a vein near the skin surface. The tip of all central venous catheters is in the superior vena cava
(SVC). There are several types of central venous catheters.
PICC line: (Groshong®, Open-ended, Power) A peripherally inserted central catheter, or PICC line, is a central venous
catheter inserted into a vein in the arm and then threaded into the SVC.

Tunneled catheter: (Groshong®, Open-ended, Power) This type of catheter is tunneled under the skin and placed in one
of the veins just under the collarbone. It is held in place by a textured cuff that lies under the skin. Only the end of the
catheter is brought through the skin.
Catheter tip types:
Groshong® – tip is rounded with slit-type opening that opens and closes with flow of fluid/med/etc. Does not require
heparin flush for maintenance.
Open-ended – tip is open-ended. Requires heparin flush for maintenance.
Power – usually purple in color, able to withstand pressures needed to accommodate contrast.



PICC line Tunneled Catheter







POLICY:
Nurses will utilize the following guidelines to provide care for and change a central venous catheter dressing.

Central line dressings are to be changed every 7 days OR if damp, visibly soiled, loose, bloody, or when close
inspection of the site is necessary.

Catheters cannot be submerged under water. Showering is permitted if precautions can be taken to reduce the
likelihood of introducing organisms into the catheter and the catheter and connecting device can be protected
with an impermeable cover during the shower.

SUPPLIES:
gloves to remove dressing
adhesive removal wipes (optional)
central Line dressing change kit
Biopatch®
Alternate dressing for sensitive skin or reaction to Tegaderm: SorbaView® 4” square (if needed)
Additional supplies needed, if not in dressing change kit;
o sterile gloves to perform site care and apply dressing
o alcohol swab sticks to remove dried blood, adhesive, or exudates
o 2% Chlorhexidine (ChloroPrep®) 3-pack applicator swabs
o skin prep swab stick
o Transparent Adhesive dressing

NOTE: Patients will have necessary dressing supplies provided by their home infusion pharmacy and
should be instructed to bring them to clinic for catheter care/dressing changes.

PROCEDURE:
1. Introduce yourself. Identify patient by full name and date of birth. Provide privacy.
2. Verify patient’s need for dressing change: verbally and by date on intact dressing.
3. Verify allergies, specifically to chloraprep, adhesive.
4. Wash hands. Gather supplies.
5. Apply mask, then clean gloves.
6. Assemble supplies:
a. Open dressing change kit
b. Add additional needed supplies (not included in dressing change kit): BioPatch®, StatLock®,
adhesive dressing, etc.

7. Remove dressing with exam gloves taking care not to dislodge catheter. Use alcohol wipes or adhesive
remover wipes for easier release as you peel the dressing from the skin.
NOTE: When removing dressing, make sure the pulling motion is UP the arm, not down.



8. Remove the line securement device:
a. StatLock® – follow steps below:
i. Stabilize one of the StatLock doors and open the opposite door by pulling UP on the lower
edge of the door (not the center). Repeat the process for the other door.
ii. Gently remove the catheter from the StatLock®. You may wish to secure the catheter with
tape prior to this step to ensure that it does not become dislodged.
iii. Using alcohol, soak an edge of the StatLock® until a corner is lifted. Allow the alcohol to
seep under the pad of the StatLock® and dissolve the adhesive. Then remove StatLock®.

9. Remove BioPatch® and/or any remaining dressing and discard in proper container.
10. Inspect the insertion site for redness, swelling, tenderness, skin irritation or breakdown, odor, drainage,
exudate, or migration.
11. Measure the external length of the catheter
12. Remove gloves and sanitize hands with sanitizing gel or re-wash hands.
13. Apply sterile gloves
14. Clean the insertion site
a. If there is dry blood or other material present at the insertion site, use the 3 alcohol swabsticks to
clean the skin and suture area.
b. Carefully open the ChloraPrep® swabstick package. Using all 3 sticks, do a friction scrub (press
down & scrub in all directions) for 30 seconds (10 seconds for each swabstick), completely wetting
the 4 x 5 inch treatment area with antiseptic. (If you are using a ChloraPrep® wand, do one 30-
second scrub.)
c. Allow to dry completely (at least 30 seconds). Do NOT blow dry, blot, or wipe away.
15. Apply skin protectant/barrier where the securement device and transparent dressing will touch the skin.
Allow to dry completely.
16. Place BioPatch® around catheter site – printed side up/foam side down. Ensure that entire patch is
touching the skin. Align catheter with slit in patch.

17. Apply securement device:
a. StatLock®:
i. Loosen the doors by opening & closing them once.
ii. Place catheter into StatLock® by putting catheter wing holes over the posts of the
StatLock® and closing plastic doors one at a time.
iii. Align the StatLock® anchor pad so directional arrow points toward insertion site. Apply the
StatLock® to skin and peel away the paper backing, one side at a time, pressing the
StatLock® pad in place.


18. Apply dressing:
a. Transparent adhesive dressing – should be centered over the insertion site; change every 7 days or
if wet, soiled, etc.
b. Alternate dressing
i. For a bleeding or oozing site, it is preferable to initially use a sterile gauze dressing. If this is
necessary, remove the old/soiled dressing as described above. Replace the BioPatch® and
change the gauze, then cover with a transparent dressing. This should be done as needed or
at least every 2 days. Do not remove the securement device with every dressing change
unless it is soiled or loose. Site care should be performed every 7 days.

ii. For patients with sensitive skin, you may choose one of the following:
Sterile 4 x 4 gauze dressing secured with a minimal amount of paper tape or pink
hy-tape around edges of dressing. Change gauze every 2 days (leaving BioPatch® in
place unless soiled), site care every 7 days.
SorbaView® – dressing with a transparent center surrounded by a telfa strip and
hypoallergenic tape border. When used with BioPatch®, should be changed every 7
days.

19. Use dressing change label from kit to indicate date of dressing change. Apply directly on the dressing but
NOT over the insertion site.
20. Check each lumen of the catheter for patency by aspirating for blood return.
21. Flush each lumen and line with 20ml normal saline, followed by heparin, if indicated by line and valve
type.
22. Documentation in Progress Notes section of HealthLink:
Patient education
Procedure performed, date & time completed
Condition of catheter insertion site and skin
Measurement of external length of catheter
How the patient tolerated the procedure
Discharge instructions
Follow-up appointment (if any)


WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator, 2012

REVIEWED BY: LaVay Morrison RN, BSN, Clinical Staff Educator, 2012
Shar Ballentine, RN, BSN, Clinical Program Coordinator, Chartwell Midwest Wisconsin
Susan Antonie, RN, Hematology/Oncology Clinic, UWMF, 2012
Susan Antonie, RN, Hematology/Oncolocgy Clinic, UWMF
Julie Nampel, RN, Clinic Mgr, Hematology/Oncology, UWMF & GYN/Med/Oncology, UWHC
Rebecca Harrison, RN, Urgent Care, Team Lead
Brian Tish, RN, Urgent Care, Team Lead







REFERENCES:
Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Society.

UWHC Departmental Policy 1.21. (April 2, 2012). Central venous catheters, adult and pediatric. U-connect, faculty and staff intranet
for UW Health. Available at:
https://uconnect.wisc.edu/servlet/Satellite?cid=1095721213003&pagename=B_EXTRANET_UWHC_POLICIES%2FFlexMember%
2FShow_Policy&c=FlexMember.



AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine

_______________________________________________________________________________
Medical Director, UWMF

________________________________________________________________________________
Vice Chair, Department of Family Medicine