This document provides guidance on peripherally inserted central catheter (PICC) and central venous catheter (CVC) dressing changes and care. It discusses assessing the condition of dressings, indicators for changing dressings, cleaning and dressing change techniques, and documentation requirements. Key steps include cleaning the site with chlorhexidine, using aseptic technique, changing dressings based on integrity and dryness, and documenting assessments, interventions, and patient education.

1. 1
Kelly B. VanParys, RN BSN
Revised 2016

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4. The CONDITION OF THE PICC/CVC
DRESSING
&
PICC DRESSING CHANGE TECHNIQUE
BOTH
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5. 1. POOR SKIN PREP
2. DRESSING NOT INTACT
3. DRESSING WET/DAMP
4. DRY BLOODY DRAINAGE OR NEW DRAINAGE LEFT UNDER
DRESSING.
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NO
YES

6. DURING
IF HAS BEEN USED.
1. PHLEBITIS (CHEMICAL OR MECHANICAL)
2. THROMBUS
3. NEED FOR REPLACEMENT OF PICC BECAUSE THE TIP IS NO LONGER
CENTRALLY LOCATED.
4. LOSS OF CATHETER
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8. a bandage or dressing that closes a wound and excludes
it from the air.
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OR

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12. Evidence-based recommendations from the Infectious Diseases Society of
America (IDSA)/ Society for Healthcare Epidemiology of America (SHEA) on the
use of Antimicrobial Patches.
THE USE OF ANTIMICROBIAL PATCHES IN THE
FOLLOWING PATIENT POPULATION:
1. Patients with limited venous access
2. Patients with a past history of CLABSI (central line blood stream infection)
3. Patients who have an increased risk for severe consequences from a CLABSI
(i.e., transplant, cancer, valve replacement).
If using an antimicrobial patch, place the slit towards the wings of the catheter to
prevent dislodging of catheter when removing dressing.
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SLIT
Completely Surround the Catheter.
Don’t “Sit” Patch on top of catheter.

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14. 1. Remove Sterile Gloves
from Dressing Kit and
Set Aside.
2. Drop Securement Device
onto Sterile Field.
3. Drop Antimicrobial
Patch, if used, onto
Sterile Field.
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15. 1. Remove Old PICC DRESSING
by STARTING at the HUB
END and Pulling TOWARDS
the INSERTION Site.
 This helps prevent
dislodging the catheter.
2. Remove OLD SECUREMENT
DEVICE & ANTIMICROBIAL
PATCH.
 BE CAREFUL NOT to
touch Insertion Site or
Catheter Area ABOVE
Securement Device.
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17. 1. To remove, stabilize catheter and
lift up on each clear tab (if
applicable).
2. Lift up PICC line carefully to
remove securement device from
arm.
• Remove carefully to prevent
skin tear.
• Remember to ONLY TOUCH
those areas of catheter that
have NOT been UNDER
PREVIOUS PICC DRESSING.
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20. This is the result of placing the
TSM dressing before the
antiseptic solution had a chance
to dry completely!
 The adhesive from the dressing
reacts with the antiseptic and
causes a !
 Patients often think they are
allergic to “adhesives”.
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24. 1. Supplies for site cleansing and dressing changes should be single-use; refer to
manufacturer’s recommendations to ensure compatibility with the catheter
material.
2. Maintain aseptic technique.
3. Always perform hand hygiene before touching patient, before applying and after
removing gloves, and after performing procedure.
4. Wear clean or sterile gloves, depending on the procedure(additional precaution
per Infusion Nursing Society includes use of facemasks and sterile gloves).
5. Apply antiseptic to the site using >0.5% chlorhexidine preparation with alcohol;
if there is contraindication to chlorhexidine, use tincture of iodine, an iodophor,
or 70% alcohol as alternative.
6. Do not apply topical antibiotic ointment or creams to catheter site.
7. Cover with either sterile gauze or sterile, transparent, semipermeable dressing
(refer to catheter-specific recommendations for frequency of dressing changes).
8. Monitor external length: Easiest assessment piece that provides us with the
most information to proactively monitoring for potential complications
associated with tip migration.
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25. Measure upper-arm circumference when clinically
indicated to asses the presence of edema and possible
DVT. (New INS 2016 Standard)
Take measurement in same place as the documented
baseline measurement.
Infusion Nurse Society(INS) has standardized where to
measure mid-arm circumference: 10 cm above the
antecubital area.
Compare to measurements taken at time of
insertion/SOC.
If circumference is > 3 cm from insertion/SOC AND the
catheter is NOT functioning properly AND/OR the
patient complains of pain or discomfort;
Notify the provider as the patient may have a DVT and
the recommendation is for an ultrasound of the
extremity.
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27. .
• PRE-PRIME a NEW NEEDLELESS ACCESS
DEVICE (NAD) with A 10-ML 0.9% Sodium
Chloride PRE-FILLED Syringe.
• CLAMP PICC BEFORE REMOVING THE NEEDLELESS
ACCESS DEVICE (NAD) FROM THE END OF THE
PICC LUMEN;
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28. • SCRUB END OF PICC
LUMEN with antiseptic
swab.
• Do this with a twisting
motion at LEAST 15-20
seconds & let dry
completely.
Note: Once the NAD is
removed, the end of the
PICC should never touch
the patient’s skin
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29. 1. Attach new PRE-PRIMED
NAD to the END OF PICC
LUMEN.
2. Unclamp Catheter Lumen,
if clamp is present.
3. Using a 10-ml Prefilled
0.9% Sodium Chloride
syringe, FLUSH catheter
lumen using a PUSH-
PAUSE TECHNIQUE.
4. REPEAT Procedure to each
catheter lumen.
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30. PICC/CVC
CARE AND MAINTENANCE
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31. 1. Check that each lumen has return upon aspiration.
2. Check that each lumen of the PICC/CVC can be
FLUSH EACH CATHETER LUMEN with 10-ml 0.9% Sodium Chloride using
push-pause technique
Per Infusion Nurse Society: “TEN (10) 1-ml bolus pushes”.
This technique is used to create turbulence inside the catheter to help keep the catheter patent.
1. Flush lumen with 10ml NS before & after medications.
2. Flush lumen with20 ml NS after blood draw.
3. Flush lumen with 20 ml NS after discontinuing TPN/lipids, or blood.
**Do not draw labs from a !!!
(infection risk)
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32. Does you PICC/CVC on the
CATHETER LUMEN from the Manufacturer?
If so, this type of PICC will need to be flushed with
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33. If your PICC DOES NOT HAVE a CLAMP on the lumen
placed by the manufacturer, (it has a VALVE);
This type of PICC should NOT need to be flushed with
Heparin
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35. When is DISCONNECTED from
the PICC/CVC Line;
The of the
must be protected with a
PATIENT’S Medication Infusions are COMPLETE for the 24
hour period.
(If this is the case, DISCARD the IV Administration Set in appropriate waste
bin.)
DO NOT ENCOURAGE YOUR PATIENT’S TO USE THE WHITE CAP FROM THEIR 10-
ML O.9% SODIUM CHLORIDE SYRINGE IN PLACE OF THE STERILE DEAD END CAP!
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36. Infusion therapy-related lawsuits are among the fastest-growing
categories of litigation brought against nurses.
HOW YOU DOCUMENT the IV CARE YOU PROVIDED can clearly identify
the difference between MALPRACTICE and MISADVENTURE.
Your documentation must demonstrate to anyone reviewing it later that
the CARE PROVIDED MET THE STANDARD OF CARE.
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ACCURATE
DOCUMENTATION

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In other words DO NOT USE phrases such as "no swelling, no redness, no
leakage observed".
These phrases have not held up in courts of law, and a creative plaintiff attorney can make it appear that you
did not assess the patient for anything else!
Use instead "No signs and symptoms of IV-related complications observed,“
The use of UNIVERSAL STANDARDIZED ASSESSMENT SCALES are strongly recommended.

38. GENERAL
IV /VASCULAR ACCESS DEVICE DOCUMENTATION
REQUIREMENTS
1. IV starts and site rotations
2. Dressing changes
3. Tubing changes (patient education r/t change frequency)
4. Change in orders
5. Site checks (even if dressing change is not needed)
6. Complications and your interventions.
7. IV-related communication with other healthcare professionals (who did you
talk to, what time, what did they say?)
8. Discontinuance of therapy (Why discontinued? Therapy complete? Infection?
DVT? Etc.)
9. Condition of the catheter upon d/c. (Catheter intact, bent? If PICC line,
compare the length reported on referral to the length of PICC line removed
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39. ACCESSING - RELATED DOCUMENTATION REQUIREMENTS
According to the Infusion Nursing Standards of Practice (INS):
1. Type, length, and gauge of the catheter inserted (for a PIV or Huber needle)
2. Date and time of insertion
3. Number/location of attempts
4. Name of the vein (PIV)
5. Type of dressing applied to the site (gauze vs. transparent)
6. How the patient tolerated the procedure
7. Name of the person inserting the device.
Also Document:
1. Specific safety or infection control precautions (site prep, use of an antimicrobial patch, securement device, etc.)
2. Relevant patient and caregiver education (what you actually SAID vs. check marks)
3. Any barriers to care or complications that occur (unable to obtain blood return with a PICC, etc.)
4. Any comments made by the patient about the insertion.
5. The medication/fluid delivered through the IV/lumen (what type of medication is line/catheter being used for, etc.).
6. Definitely document any deviations from policy and the reasons for same, since policy will be used as a standard to
benchmark your care.
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40. 1. Label Dressing With Date and Initials.
2. Document What You Cleaned the Site With, Securement Type
Used, Dressing Type Used, if antimicrobial patch used.
3. Document External Length of PICC line.
4. Document Arm Circumference and Location Measured
(weekly).
5. Document PICC Function (+ Brisk Blood Return?, Flushes
Without Resistance?, What Solution Did You Use to Flush,
NS/Heparin or both?)
6. Document Insertion Site Assessment (Universal
Phlebitis/Infiltration/Extravasation Scales Recommended)
7. Document Any Issues Requiring Provider Notification; Date,
Time, Who You Spoke With, and Their Response.
8. Document Further Interventions, if applicable.
9. Document Patient Tolerance To All Interventions.
10. Document Patient Teaching/Instructions Provided.
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42. 1. Infusion Nurses Society, (2016). Policies and Procedures for Infusion
Therapy. Norwood: Wolters Kluwer.
2. Infusion Nurses Society, (2014). Core Curriculum for Infusion Nursing.
Pennsylvania; Wolters Kluwer Health/ Lippincott Williams & Wilkins
3. Infusion Nurses Society. (2011, January/February). Infusion Nursing
Standards of Practice. Journal of Infusion Nursing.
4. Alexander, Mary, et al. (2010). Infusion Nurses Society Infusion
Nursing: An Evidence-Based Approach, Missouri; Saunders Elsevier.
5. Judy Hankins, R. A. (2001). Infusion Therapy in Clinical Practice.
Philadelphia: W.B. Saunders Company.
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