Chapter 32 ■ Central Venous Catheterization 201

2. To prevent migration of the catheter, secure it to the

skin a few millimeters from the insertion site with a

small piece of sterile tape (avoid using tape that contains wire).

3. If the catheter has not been trimmed, loosely coil the excess

length of catheter close to the insertion site and secure to

the skin with more sterile tape. Ensure that there is no

kinking or stretching of the catheter under the dressing.

4. Apply a semipermeable transparent dressing over the

area surrounding the insertion site.

5. Do not allow tapes or transparent dressing to extend

around the extremity. The dressing will form a constricting tourniquet as the infant grows or if there is

venous congestion.

6. Place tape under the catheter hub and criss-cross it over

the hub (chevron). Do not obscure visualization of the

insertion site (Fig. 32.6).

7. To prevent skin breakdown, a skin barrier of hydrocolloid

material or soft gauze can be placed under the hub.

E. Dressing Changes

1. Mild oozing of blood from the insertion site may occur

for up to 24 hours. If oozing occurs, the initial dressing

should be changed when it subsides. If oozing of blood

is a problem, a small piece of thrombin foam can be

applied over the insertion site and under the dressing

for the first 24 hours after insertion.

2. The catheter site dressing should be replaced when it

becomes damp, soiled, or loose. Transparent dressings

should be changed every 7 days except in those patients

in whom the risk of dislodging the catheter outweighs

the benefit of changing the dressing (2).

3. Inspect catheter site carefully at each dressing change

(Table 32.4).

o. Secure catheter at skin insertion site with a small

piece of sterile tape strip (avoid using tape that

contains wire) and cover with sterile gauze until

radiographic confirmation of position.

D. PICC Dressings (Figs. 32.5, 32.6)

1. Antimicrobial prep solutions should be removed from

the skin with sterile water or saline and allowed to dry

before dressing is placed. Do not use topical antibiotic

ointments or creams on insertion sites (2).

Fig.32.6. PICC dressing with trimmed catheter. No excess

catheter is present externally. The silicone heart is anchored with

a piece of tape, and a sterile transparent dressing is placed over the

insertion site. With use of a “chevron” technique, another piece of

tape is placed under the catheter extension, next to the silicone

heart, and crossed over on top of the transparent dressing. (From

Klein C. NeoPicc: The Neonatal and Pediatric Workshop Manual.