202 Section V ■ Vascular Access

4. If the catheter is too far in, as confirmed by radiography

or echocardiography, it may be pulled back, prior to

replacing dressing. Do not advance the catheter, as the

risk of contamination is high.

5. Use sterile technique for dressing changes (mask, cap,

and sterile gloves; sterile gown is optional).

6. Prepare sterile field: Place drape under extremity.

Utilizing the prep solution, prepare the skin at and

around the insertion site, working outward in concentric circles. Allow the prep solution to dry. Repeat process with new gauze/prep solution. Drape prepared

area, leaving insertion site exposed.

7. Follow steps D1 through D7 to complete the PICC

dressing change.

F. PICC Care and Maintenance

1. Evaluate appearance of the catheter and the tissue

around the insertion site frequently.

2. Change IV tubing according to unit policy. Utilize

aseptic technique when changing tubing.

3. To prevent contamination of the line, enter the PICC

only when absolutely necessary.

a. Avoid the use of stopcocks in the line.

b. Always “scrub the hub” with alcohol pad (or similar

product) prior to breaking a connection.

c. If the catheter must be used to infuse medications,

arrange the intermittent injection tubing so that it

does not come in contact with the parenteral alimentation solution until the terminal infusion site.

A dedicated “closed” medication administration system is recommended (13). Gently flush tubing prior

to and after medication administration. Ensure that

the flush and medication is compatible with the parenteral alimentation.

4. Prime volumes are usually <0.5 mL. Use a 5- to 10-mL

syringe when needed to check catheter patency. Do not

use force if resistance is encountered. A small-barreled

syringe (such as a 1-mL syringe) may generate too

much pressure, resulting in catheter rupture (12).

5. Administer a constant infusion of IV fluids at a rate of at

least 1 mL/h. Follow the manufacturer’s recommendations for maximum flow rates.

6. The addition of heparin in small doses (0.5 units heparin/kg/h or 0.5 units heparin/mL of IV fluids) reduces

the risk of occlusion and prolongs catheter patency

(14).

7. Do not utilize the PICC for routine blood sampling.

8. Packed red blood cell transfusions should be given

through a PICC only if absolutely necessary. Although

there is no clinically significant hemolysis, there is a

potential for occlusion of the catheter (15).

9. Monitor quality indicators to identify and solve problems.