Nursing Management

Nursing Management

  • Inspect catheter and insertion site
  • Assess pain
  • Change dressing and clean according to institution policies
    • Transparent semipermeable dressing or gauze dressing
    • Chlorhexidine preferred cleansing agent
  • Change injection caps
    • Have patient turn head to opposite side
    • Valsalva if no clamp
  • Flushing is important
    • Normal saline prefilled syringe
    • Use only 10 ml syringe or larger
    • Push-pause technique

Removing CVADs

  • Should be done according to institution policy
  • Gently withdraw while patient performs the Valsalva maneuver
  • Apply pressure
  • Ensure that catheter tip is intact
  • Apply antiseptic ointment and dressing

Things to consider to teach the patient with a PICC line

  • Proper technique for cleansing port prior to access
  • Proper flushing technique
  • How to administer antibiotic
  • S/S of occlusion and infection to monitor for
  • Who to call if symptoms of occlusion and infection
  • Importance of clamping catheter and keeping cap connection secure
  • What to do if catheter is inadvertently open to air

How to remove a PICC line

  • Put on nonsterile gloves and remove dressing.
  • Don sterile gloves and mask; have patient turn head to other side.
  • Remove sutures if present.
  • Slowly and steadily withdraw catheter. If resistance is met, STOP.
  • If resistance is met—can apply warm compresses for 20 minutes and retry. If resistance continues, notify HCP.
  • Have patient perform the Valsalva maneuver as the last 5 to 10 cm of the catheter is withdrawn. 
  • Pressure should be immediately applied to the site with sterile gauze to prevent air from entering and to control bleeding.
  • Inspect the catheter tip to determine that it is intact.
  • After bleeding has stopped, apply an antiseptic ointment and sterile dressing to the site.