PICC Dressing Change (peripherally inserted central catheter) for Nurses

More and more, nurses are caring for patients with PICC lines both in hospitals and in the community and knowing how to complete a PICC Dressing Change is a nursing skill.
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This video demonstrates how to do a PICC Dressing Change (Peripherally Inserted Central Catheter) using a clean to sterile technique and goes through the equipment, the set up, the process. Includes assessment of arm circumference and catheter length, use of statlock securement device.
It is noted in the comments below that the second chlorhexidine swab is initiated at the outer border of the sterile field and brought in to the center. This should be started at the insertion site and cleansed outwards toward the patient's head. Also I realized the third chlorhexidine swab does not need to be turned over. Note that the side used under the IV line should stay upright when moving to the top of the line. I appreciate the Nurseminder Nation eyes that caught that. If I had access to the equipment still I would redo the video, but as with everything in life, it is not always a perfect set up.
The other method to use is a sterile to sterile technique in which you will put all your supplies inside a sterile field and then don your sterile gloves before working with the chlorhexidine swabs.
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[@mzmle363]

Just one comment. Start cleaning at insertion site and move outward from there. With third swab do not cleanse tubing distal to insertion site and then return to insertion site ... but the other way around. Always start at insertion site then move away from insertion site.

[@juleenave2102]

Seriously I thought the same thing!

[@NurseMinder]

great addition

[@geriroush8004]

that is true with alcohol or betadine. With Chlorhexadine, the back and forth scrubbing motion is what is important.

[@jagmailbrar]

Always start from less contaminated to more contaminated !!!

[@SheilaGBegnaud]

Thank you!! I was like ma’am, you just passed over a dirty line and went over the insertion site….😮

[@sharonh9242]

Great Videos....you saved another Nurse and Patient! Thank you. Wish I had a great educator like this when I was starting out in my career!

[@BriNJ1983]

I haven't even gotten into a full minute and I already LIKE'd your video because... IT'S YOU! You're so good!

[@NurseMinder]

ah, thanks

[@updownstate]

My visiting nurse cared for my PICC line so well that she kept me out of the hospital for over a year until I could have my next surgery. Nurses rule.

[@NurseMinder]

That is awesome!!!!

[@deborahkelly1489]

@@NurseMinder Thank you, very informative. I am having a PICC line placed in a couple of days. Then the nurse will come to my apartment and do the antibiotics here .

[@mikemankoff7198]

Thank you so much!!!! I am going through orientation now, and this was one of the things my preceptor and I were discussing that I needed to learn!!!! I feel so much more confident now!!!!

[@NurseMinder]

Fantastic!

[@Lovepreet_Singh93]

Doctors, Nurses and all the helping staff in The Hospital holds my Utmost Respect. You guys really work miracles. Thanks for your selfless service towards humankind. Greetings and Love from India.🇮🇳

[@doremifasolatido-ro7zs]

Thank you for appreciating the value and giving your utmost respect towards the entire healthcare workers👍🏼

[@Lovepreet_Singh93]

@@doremifasolatido-ro7zs I can see how hard and selflessly these people work. I show them my love by giving them respect and by showing some gratitude.

[@vremyagoda]

Thank you! Great video!

[@garyjean2436]

Great video! Thanks a lot.

[@mirandasmith1115]

This was so helpful! Thank you.

[@NurseMinder]

☺️

[@cierranewman4147]

I love your videos!! Thanks so much!!

[@NurseMinder]

Ah! Thank you for sharing that wonderful message. I hope you subscribe and share this with your nursing friends :)

[@Inkatown-six]

You always have to start from the puncture site first and work your way outward

[@NurseMinder]

Yes, I have the correction in the description box - if I could go back and edit that one part, I would - take pride in knowing that you were able to pick that up!

[@ediannareyesovalle9636]

Great video clear thank you!

[@NurseMinder]

Thank you

[@williamgissy7248]

Great video, thank you.

[@NurseMinder]

Thanks for writing

[@letslook123]

Good morning~Thank you so much! Have a good day~~

[@NurseMinder]

Good morning!

[@user-tk7mk2wx8r]

Thank you so much!!! It is so good!!

[@NurseMinder]

Happy to help

[@Uniquemua]

I'm glad for this video how ever it would have been better if it was on an actual patient. Thank you this is useful

[@NurseMinder]

I agree a real patient would be great -

[@redbrexit2912]

All the real patients run away at this point...

[@godiseverything9763]

Your videos are perfectly amazing. They help me a lot. God bless you

[@NurseMinder]

Yeah!

[@elizabethweld3131]

The struggle to remove the statlock was so validating haha. They can be so sticky sometimes!

[@NurseMinder]

Thanks for watching and sharing your thoughts.

[@jojimathew031]

Hi Tammy. Thank you for showing the procdedure. Entire procedure is really good and easly explained. Only one suggestion from me is when you clean with chlorhexidine i normally start from the exit site and move away then around the area. Once i have done exit site and would not go back again . Thank you

[@NurseMinder]

Yup! It is the error in my demo - :). If I had access to the equipment again, I would redo that part.

[@indigotrini]

@@NurseMinder This is really well done and clearly explained. If you can, have a look a the Nursing evidence that supports vigorous scrubbing back and forth over the entire site and allowing it to dry

[@michellemosley3177]

@@indigotrini Vigorously cleaning with the swabs can also make patients nervous by pulling the line in and out so not a good idea.

[@cyborgqueer]

@@NurseMinder I know this is an old conversation but I’m really impressed with how mature, and genuinely kind hearted this convo is. Not only is the original comment someone who has their ‘heart in the right place’, it’s also phrased kindly as is the reply. I know this is an odd comment but I don’t think enough people acknowledge kindness the way they do hate, like hateful comments Anyway great videos, ! 👍🏻💖

[@sleepmaiden]

Thank you!

[@NurseMinder]

You are welcome!

[@ginaspace3473]

Thank you so much !!! You’re a live saver ! My grandma just had a picc line placed and I have to change it...this video helped a lot!

[@NurseMinder]

that is great!

[@Immagiraffe101]

That’s strange... usually you go to an infusion clinic once a week to get it changed. As a nurse, I find it hard to believe that they have you change the dressing since it is so important to keep it sterile.

[@michellemosley3177]

@@Immagiraffe101 It's not rocket science. Not everyone lives nearby nor can neccesarily afford it.

[@rcz2023]

Thank You

[@NurseMinder]

You are welcome. If you have any videos you want to see let me k w

[@manpreetdhiman2126]

Very nice and informative video..

[@NurseMinder]

Thank you

[@Virtuewz]

thank you for sharing. we covered this briefly in lab, but this was helpful.

[@NurseMinder]

Thanks for writing Ethan

[@micahandme8078]

I am sorry but you have to scrub the insertion site first and work outward.

[@crazycanuck4617]

YES! Protocol where I work is insertion site outwards in circles, flip swab over to the "clean" side, and do again.

[@NurseMinder]

Yes you highlight a different practice that works. With time polices change back and forth so follow your practice guidelines

[@johnmorrison7205]

for christ sake I think the rubbing alcohol will take care of anything no matter how you scrub it karen.

[@Locust775]

@@johnmorrison7205 actually you puch bacteria around, and you cant be certain the alcohol will get them all. Thats why with every wound, a nurse starts in the middle and works outward :)

[@denisechavis4820]

That’s how I was taught but as long as it all gets clean is where it matters most

[@peggybuetow1026]

Should have started the cleaning from insertion site, laterally........not laterally towards the actual insertion site.

[@NurseMinder]

The hashtag method has been what we have used for quite a while now (replaced the circular method) I have not evidence to suggest that infections rates are different. If you have some, please share :). would be a great study

[@nerlyb7032]

great job thanks

[@NurseMinder]

Thanks for writing

[@wadafruit]

The comments on this KZbin video. Are ridiculous. For the most part she did everything with some critical thinking so it was not done badly. Every procedure is different and as long as you maintain the sterile process in certain principles the patient will be by. I came here because I took off 3 years from floor nursing and just starting up nursing again but then this time as a home health nurse. I had to do a PICC line dressing change and that same night the patient had complained of very bad pain. I think what I had done was maybe the tape that I put on there the tagoderm was too tight that is my conclusion. I'll find out in a few days. Just another tip so next time I put the tag-oderm on I think I'm going to put it from the middle to the outside. I think that might help with less pain. When I was at the patient's house the site was fine and everything so I'm guessing most likely the pain was due to the tape the tag of the room I mean being on a little too tight maybe. I guess this is what I get for coming back into the field. I have to get my skills back. Very nice.

[@NurseMinder]

Welcome back to floor nursing - I hope the transition is smooth for you. 😊

[@JadenYukifan28]

​@@NurseMinderI have a PICC Line in my arm and need to change the dressing regularly, it does hurt but not a lot.

[@nicholasheuermann9221]

PICC dressing changes at the patient's house can be very difficult. Especially in Hawaii with no AC, sweaty hands and trying to change to sterile gloves! Always need extra, extra supplies. (:

[@mitchellb.9877]

Quit cleaning far outside then moving swaps inside. Start inside and move outwards

[@NurseMinder]

Yes you are right

[@lissyantony7385]

very nice

[@NurseMinder]

😊

[@jonleonard5373]

good morning 🌞

[@jonleonard5373]

Yes he's Jon and boxtion eating at home

[@NurseMinder]

Good morning!

[@pam9776]

wish there was another video using a dressing tray

[@NurseMinder]

A dressing tray is only a different place to keep sterile things sterile.

[@wetumankosa968]

Cleaning usually from inside of insertion outward to avoid any infection. Normal Saline clean first and decontaminate with 2% Maxi Swabs cleaning inward to outward.before you put sterile gloves wash hands with antimicrobial soap for one minute.this procedure need to be really sterile and label date after finishing so that other staff are aware when it was changed. Document after

[@NurseMinder]

Yup! Good catch. Inside out for cleaning

[@justinfacteau2328]

hello thank you for making the video. it's a great thing and lacking right now in good coverage in texts and references.

[@NurseMinder]

Yes. This is one skill often covered on the job

[@lavy1513]

I think your suppose to start cleaning at the insertion site.

[@loriloretta7639]

Yes, she's moving dirty to clean with those up and down motions, that's the first thing I noticed

[@livingangel911]

Yeh you start from insertion site and work out otherwise you are just putting the dirty onto the clean

[@livingangel911]

And she should have been sterile as soon as dressing was removed

[@petitangeus]

That is the first that I noticed also. Thank God that it a maneiken. Not a real patient.

[@jeromecavada5768]

Exactly

[@crusader6962]

My nurse uses fluid to loosen the tape to prevent skin irritation and redness.

[@NurseMinder]

It is not something I have seen with PICCs but that does not mean it is not something they were taught. They critical element is maintaining sterile processes

[@valeriecrawford1912]

Must always start inward and work outwards from site when cleaning. Possible dragging germ into the site is not sanitary.

[@NurseMinder]

Always follow your hospital policy :) (yes the cleaning is corrected in the description). Thanks for adding your knowledge to the conversation:). Some places still do circular swabs, others do back and forth

[@doremifasolatido-ro7zs]

Do handwashing with soap and water or handrubbing with alcohol before donning and after doffing the gloves 🧤 i noticed too that there is no sheet being place underneath the patient's arm. The sterile dressing set should be open and place the chlorhexidine swab and gauze after opening them from their individual package to prevent from contamination.The actual cleaning of the affected site should be done ideally from cleanest to dirtiest

[@elizabethweld3131]

I noticed the lack of hand hygiene before applying the sterile gloves as well! And the cleansing of the site from insertion site outwards is something that we were taught. We don't add our chlorohexidine wipes to the sterile field per our facility policy. Everything varies by location!

[@ServiceDogRosie]

I always place it under for my line

[@NurseMinder]

:)

[@lifeofchronicallydani]

I have a picc line and it turns out that I am having an allergic reaction to the cholorhexadine and biopatch but was told I still had to use them cause there is nothing else that can be used. Is that true? I am watching to educate myself cause every nurse seems to do it different and I get confused. Thank you for this video.

[@HoneyBunny0225]

Hi Dani! I'm a Registered Nurse! I'm very sorry to hear that you're having an allergic reaction to Chlorhexidine (Biopatch). Some people are more sensitive to topical antiseptics so definitely talk to your doctor about other alternatives! The FDA suggests, "using alternative antiseptics such as povidone-iodine, alcohols, benzalkonium chloride, benzethonium chloride, or parachlorometaxylenol (PCMX) when any previous allergy to chlorhexidine gluconate is documented or suspected" (FDA.gov, 2017). If you start experiencing more severe reactions like swelling of the face, wheezing, hives, difficulty breathing this is a medical emergency and you should be treated as soon as possible. Hope the info in the link below finds you well. Reference: www.fda.gov/media/102986/download

[@NurseMinder]

The PICC nurses usually have some great suggestions and I hope you were able to connect with one

[@emiliefitzpatrick8856]

You can use the alcohol free soluprep swabs (chlorohexadine swabs), povidone wipes or Normal saline (absolute last resort).

[@odoemenastanley4723]

Thank u Tammy for making this video, it s really helpful. Where. Exactly does the measurement end? The thin part of the catheter or the point where needleless connector is attached?

[@NurseMinder]

In this video I believe I showed the measurements to the catheter hub. Most have hashmarks on them that will read off every 5 cm. So you would look for the one closest to the hub

[@Zippy15]

I have a home health nurse who changes mine but they always have me look way. I've always been curious what they're doing over there lol

[@CuddlyJon]

You should ask to wear a mask so that you can watch!

[@NurseMinder]

Now you know!

[@alisonjohnson1701]

No bio patch?

[@NurseMinder]

It is not always used in our facility. It is an option

[@Jessicad654]

It seems almost impossible for the line to not get pushed back in or pushed out. When my patient breathes, the line pushes out. So overwhelming

[@NurseMinder]

There is a tape in the kit which is for this exact purpose.

[@thomasc6127]

Does biopatch come before stat lock or after?

[@NurseMinder]

I have not worked with biopatches, I. hope someone who has can share

[@michellemosley3177]

Follow the slit and place around the line at the insertion site, blue side up and foam side down.

[@sijothomas6071]

are you not changing neutrons

[@NurseMinder]

did I say neutrons ... or neutral connectors?

[@jerseycornboy]

Use skin prep and never be able to take off the stat lock! Don't use skin prep there is no need for it. That stat lock is like using crazy glue alone. You have to be careful to not cause a skin tear when taking off all these highly adhesive parts.

[@NurseMinder]

Yup that statlock definatley had skin prep and being a plastic mannequin added unique challenges! More alcohol swabs needed.

[@loriransom4635]

Would like to know what to do if your PICC line has been pulled out, say about a inch? Is it critical?

[@NurseMinder]

In our facility there have been some changes. We used to have to call the PICC nurse and they would assess it. Now the floor nurses who take additional training have some flexibility to reinsert the line. That is a great facility policy question :)

[@BallerinaKristina]

NEVER let anyone-even a nurse-push the same line back in! You can get sepsis that way. Once a line has migrated out it has to stay out and take X-ray to confirm whether placement is still considered central.

[@pam9776]

weird my policy is wear sterile gloves during the cleaning and move from inside to outside with swab notgoing back towards the exit site over and over

[@NurseMinder]

Yup - there will be differences that you need to be aware for your facility - and that can change in the same city.

[@alicegaravalia5559]

You skipped the part where the line was dislodged

[@NurseMinder]

I did not skip it, it was not a part of the lesson. The small movement was due to the plastic arm. If ai had equipment- I would share how to work with it - but as policies are different, be sure to ask your educator

[@nikkbee88]

What is the name of that dressing and size. My home health has no idea what I am talking about.

[@NurseMinder]

The tegaderm? I have a link - I do not know this company, simple search will find companies your office deals with lifesupply.ca/3m-1685-tegaderm-i-v-advanced-securement-dressing-8-5-x-11-5cm-50-box-case-of-4/

[@lilianelabellebelton]

What is the method to change the caps? In a sterile manner

[@crazycanuck4617]

Oncology nurse here: I usually attach the syringe of saline to the clean cap while it is still in the package, not contaminating it. Swab the connection well where the old cap connects with the line with alcohol, then unscrew, and get the patient to hold it upright if able while not touching the open end while you get the syringe and new cap. Put a few drops of saline in the line in the "air space" you may see when the old cap is taken off, then screw the new cap and syringe on, then flush.

[@NurseMinder]

Cleanse the old cap and hub before removing, let air dry. Prepare new cap and prime. Remove old, maintaining sterile technique and replace new. Flush / lock

[@blushy3001]

Oct 23, 2015

[@sanjayshrestha193]

Today i change the dressing of my pt.after that i try to flush the line with heparin but i feel resistance and did not see the back flow of the blood. what might be the cause?

[@NurseMinder]

Blood clot, kink in line,

[@SandeepKaur-vu6ns]

Thanks for the video. Are there any other tips or tricks other than the tape method to prevent the migration of the line? What happens if the line comes out a little or migrates? Thanks

[@NurseMinder]

Most lines I see now are secured and as I understand it if it migrates out certain level like there’s a parameter where the nurse can re-insert it but I don’t know what that is I haven’t worked with them for a little while now

[@anastasiaragan1694]

I was told by my picc team to remove the dressing half way, so I can change the stat lock and the rest of the Teagarden still holding the line in place. Therefore, preventing its movement. And then once I have new statlock, remove the rest

[@melissamiller722]

I struggle with not pulling it out because we are not allowed to insert it even if a little, the statlock doesn't help either 😭

[@Cat15210]

@@anastasiaragan1694 That doesn't make sense. Changing the statlock should be a sterile process since it will be under the dressing near the insertion site. If you pull the dressing halfway back, you'd have to do a sterile statlock change, then pull off the dirty dressing (thereby contaminating your sterile gloves), and then you'd have to re-sanitize your hands and put on new sterile gloves.

[@shelisajones5145]

I am a practicing nurse for over 30 years these instructions need to be revised #1 the BIO PATCH is a MUST and the cleaning TECHNIQUE inwardly >outward ALWAYS STERILITY was not used

[@NurseMinder]

I appreciate the feedback. Biopatches are not a universal tool and come and go depending on the orders of the day. Cleaning has changed back and forth from circles out to scrubs back and forth over the years. Always work with your facility policy and check with your educators

[@damesaphira9790]

Depends....are you doing a cleaning or a sterile prep? Clean procedure you clean the gunk off. THEN you sterile prep from in to out.

[@taurus-queen8066]

If you are a practicing nurse for over 30 years. Then you should know, depending where you live, your facility guidelines all matters when it comes to orders and protocols. On top of that, nursing/healthcare changes throughout time. In the comment section, she has said many times, follow your facility guidelines. So, It’s annoying to see when someone wants to boast about being active in a career field for so long. But yet don’t understand the changes and differences that comes with said field. 😕

[@dannychew6023]

Is there a clinical rationale as to why we measure the length of dressing before and after dressing change?

[@haylee4009]

Danny Chew they measure the line not the dressing, just to make sure they haven’t pulled it out / pushed it in more than it’s supposed to be

[@NurseMinder]

to ensure we have not dislodged the line during our cleaning.

[@82Brightstar]

Yes she didn’t explain that for people who don’t know. And didn’t explain from where to where we should measure. And I prefer to start cleaning from insertion point Otherwise video was nice! 😊

[@user-om8hz4mp4u]

shouldn't we measure before applying the tegaderm, to adjust in case?

[@NurseMinder]

Great question.The measuring tape is not sterile, it needs to be done before the dressing is removed and after the new dressing is applied.

[@lhostra82]

Very educational, a little different procedure compared to where I work, but not really hygienical, I noticed. You should never wear watches when taking care of patients. The wrist watch is home of billions of bacterias! Read WHO´s hygien recommendations! People die from sepsis because of poor hand hygien. The cleaning procedure should be improved a little, for the patients safety. A PICC-line is connected directly to the heart and leads any bacteria directly out in the whole body. Desinfect hands just before taking gloves on, and immediately after taking them off. Never wear wrist watches, rings, nail polish, fake nails. And never let hair or id-cards hang down in the working area. I often see exactly these things in videos, and I really don't understand why? I really hope nurses and doctors don't do this in real life with real patients. But anyway, this is a really good pedagogic video! Thank you!

[@NurseMinder]

yup watch wearing comes up a lot in discussion.

[@williamgissy7248]

Are we not using a bio patch anymore?

[@NurseMinder]

William gissy thanks for the question. Yes, biofilm may be a part of your dressing and it is applied after the skin is cleansed with chlorhexidine wash and before you apply the tegaderm.

[@juliehomer]

Biopatch???

[@NurseMinder]

Yes, sometimes it is ordered, you need to always check your patient orders and care policies :)

[@ratkwenyehshunt1788]

You forgot your biopatch.

[@NurseMinder]

We don’t always use them

[@anastasiaragan1694]

My hospital doesn’t use bio patch either

[@marybrite7032]

What is a biopatch

[@boombanga1]

Biopatch should only be used for immuno compromised patients, not necessarily for every PICC.

[@ratkwenyehshunt1788]

Didn't know that. Is that a facility thing?

[@JibronLames]

Don't forget to place a biopatch

[@NurseMinder]

a biopatch is something that is used, but not as a routine practice here. Great addition!

[@maryellencouse7592]

If this was a real person you would have inflicted a lot of unnecessary pain. I’ve had a picc line for three months. You can’t press the locks on to the patients arm. It hurts like hell.

[@NurseMinder]

Fair point. Thanks for adding to the conversation

[@pshtiwanhassan8398]

ببورە دکتۆرە بەس سەرەتا بەیەك دانە هەمووی پاك بکەیەو لە پاشان دووانەکەی تریش بەهەمان شێوە باشتر نیە پاکتر نابێ

[@NurseMinder]

Translation?

[@sarahsessoms2685]

, ,

[@viviannesilver4392]

The technique you are using to handle the PICC insertion site is terrible!!!! You should be cleaning from the insertion site outwards, otherwise you are introducing bacteria from potentially outside the sterile dressing into your insertion site resulting in an infection. Please do not produce online instructional videos without the fundamental knowledge on what principles must be upheld such as sterile technique and prevention of invasive line infections. Ps: the reason you had so much trouble getting the statlock off was because the alcohol swab is suppose to be wiped below the device, not rubbed over the top. You should also not pull the tegaderm dressing to lift it as it could cause a skin tear, particularly in the elderly population.

[@NurseMinder]

Thanks for adding to the conversation. Just to ease your mind: The trouble with the statlock was because of the mannequin and the use of an adhesive by the previous instructor. They get harder to remove. Your blanket statement about the technique being horrible is off base. You bring a good point forward about one element of the demonstration and that is appreciated.

[@geriroush8004]

When using chlorhexadine, the back and forth scrubbing (with friction) is appropriate, scrub for 30 seconds and allow to dry.

[@JoanneCharbonneau1]

Very bad use of the dressing. The dressing is not properly placed and the 2 additional parts are not placed correctly or at a good location...

[@NurseMinder]

It is possible your organization teaches a different process. That does not make this demonstration incomplete, just different to what you know

[@VeronicaBernal-mm2sv]

Wrong way to do it, very bad info

[@NurseMinder]

Every facility will have its own policy and you need to follow your guideline. To add to the conversation, you can share what is different for you. There has been a good discussion in the comments about this very important process

[@JadenYukifan28]

​@@NurseMinderAgreed, everyone has their own way of doing it, not even everyone has to do it the same way.