Supplies
What type of flush should be utilized?
What is, either heparin or normal saline depending on order.
When cleansing each lumen, what cleaning material should be used.
What is, isopropyl alcohol 70% swab.
Things to do before procedure.
What are, verify the order, gather supplies, introduce patient, perform hand hygiene, provide privacy, explain procedure and verify patient identifying information.
When removing the dressing, in which direction should the nurse work?
What is, from distal to proximal.
Will sterile gloves be required?
What is, Yes.
During the procedure, who wears PPE.
What is, both. The patient and the nurse should both wear surgical masks to prevent infection.
Before removing the dressing, what should the nurse assess?
What is, assess the dressing and IV site for signs of infiltration, infection, pain, inflammation and tenderness.
If IV is infusing, what is the appropriate intervention?
What is, IV infusion should be momentarily paused during dressing change.
Normal Saline syringe size.
What is, a normal saline flush of no smaller than 10mL is required to prevent increased pressure in the lumens.
Can this procedure be delegated to unlicensed personnel.
What is, No. Due to the nature of it being a sterile procedure.
What is the positioning appropriate for the procedure.
What is, any position comfortable to perform the procedure. If patient has a PICC, ensure that patient's arm is is extended from the body below heart level.
Number of medical masks required for the procedure.
What is two masks.
Benefits of a chlorhexidine impregnated dressing versus a chlorhexidine disk with a Tegaderm dressing.
What is none. Due to a research study in 2018 by the Australian Journal of nursing, there are no significant clinical differences in the use of a chlorhexidine impregnated dressing in the prevention of infection versus a standard chlorhexidine disk and Tegaderm dressing.
Margatho, A. S., Ciol, M. A., Hoffman, J. M., Reis, P. E. D., Furuya, R. K., Lima, D. A., … Silveira, R. C. (2019). Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial. Australian Critical Care, 32(6), 471–478. doi: 10.1016/j.aucc.2018.11.001
What should be documented on the dressing?
What are, the date, time of change, and initials.
When cleansing the site, how should the chlorhexidine be applied.
What is, gently starting with a back and forth motion at the insertion site, slowly moving outward in a soft scrubbing motion covering at least two to three inches.
When setting up the sterile field, in which direction should the nurse pull the flaps from the dressing change tray.
What is, towards the nurse, never reach over the tray and pull away.
A student nurse is performing a sterile dressing change with line flushing on a patient with a PICC line. Which action by the student nurse causes the nursing instructor to intervene?
1. The student nurse aspirates for blood return before flushing each lumen.
2. The student lifts the head of the bed up to 45 degrees, with the arm extended below heart level.
3. The student nurse silences the beeping IV pump after removing the initial dressing, and before donning sterile gloves.
4.The student nurse allows the patient to talk during the procedure through his surgical mask.
3. The student nurse silences the beeping IV pump after removing the initial dressing, and before donning sterile gloves.
Rationale:
1. Assessing for positive blood return indicates line patency before medication or fluid administration through a lumen.
2. This is an acceptable position for this procedure. Having the patient's arm below heart level reduces risk of air embolism.
3. The patient's IV infusion should be stopped before beginning the procedure. Stopping the infusion will minimize likelihood of of air entering CVAD.
4. The patient as well as the nursing staff should both wear masks during the procedure to prevent any microorganisms from the mouth to enter the site during the dressing change.
What contraindication is noted in the pediatric population?
What is, the use of chlorhexidine is contraindicated in infants less than two months of age. Iodine and sterile water should be used instead.
When flushing a line, should the lumen be aspirated for blood return.
What is, Yes.
If a PICC becomes dislodged, but is still in, what should be the nurses first action.
What is, notify primary provider immediately for PICC line placement confirmation.