What is the proper procedure for changing a Peripherally Inserted Central Catheter (PICC) dressing?

Proper Procedure for Changing a PICC Dressing

The proper procedure for changing a Peripherally Inserted Central Catheter (PICC) dressing requires using maximal sterile barrier precautions, 2% chlorhexidine in 70% alcohol for skin antisepsis, and either sterile transparent semi-permeable dressings changed weekly or sterile gauze dressings changed every 2 days. 1

Preparation and Hand Hygiene

• Hand hygiene procedures, including washing hands with conventional soap and water or alcohol-based hand rubs, must be performed before and after all catheter-related interventions 1
• Use maximal sterile barrier precautions including cap, mask, sterile gown, sterile gloves, and a sterile drape for dressing changes 1
• Gather all necessary supplies before beginning the procedure to maintain sterility throughout 1

Skin Antisepsis

• Prepare the skin with a 0.5-2% chlorhexidine preparation with alcohol (2% chlorhexidine gluconate in 70% isopropyl alcohol is preferred) 1
• If there is a contraindication to chlorhexidine (such as sensitivity or in infants under 2 months), use tincture of iodine, an iodophor, or 70% alcohol as alternatives 1
• Allow the antiseptic to completely air dry according to manufacturer's recommendations before applying the new dressing 1

Dressing Selection and Application

• Use either sterile gauze or sterile, transparent, semi-permeable dressing to cover the catheter site 1
• For the first 1-2 days after insertion, placement of sterile gauze between the PICC entry site and adhesive dressing is appropriate 1
• If the patient is diaphoretic or if the site is bleeding or oozing, use sterile gauze dressing until this is resolved 1
• After initial insertion period, use clear, transparent dressings that permit site examination 1

Dressing Change Frequency

• Replace gauze dressings every 2 days for short-term CVCs 1
• Replace transparent dressings at least every 7 days 1
• Change dressings sooner if they become damp, loosened, or visibly soiled 1
• For tunneled catheters with well-healed exit sites, there is no definitive recommendation regarding the necessity for dressing 1

Catheter Stabilization

• Use manufactured catheter stabilization devices rather than sutures to secure the catheter whenever feasible 1
• Sutures should no longer be used routinely for securing the catheter as they may be associated with a higher risk of contamination 1

Additional Considerations

• Do not apply topical antibiotic ointment or creams on insertion sites as they may promote fungal infections and antimicrobial resistance 1
• Consider chlorhexidine-impregnated dressings for patients with short-term catheters who are at high risk for infection 1
• Monitor the catheter site visually when changing the dressing or by palpation through an intact dressing on a regular basis 1

Common Pitfalls and Caveats

• Never submerge the catheter or catheter site in water; showering may be permitted with appropriate precautions 1
• Avoid using organic solvents (e.g., acetone, ether) on the skin before or after applying antiseptic 1
• Never advance a migrated PICC regardless of how far it has been dislodged; guidewire exchange is the appropriate approach if the PICC needs to remain in place 1
• Daily skin cleansing with a 2% chlorhexidine-impregnated wash cloth may help reduce the risk of catheter-related bloodstream infections 1

By following these evidence-based guidelines for PICC dressing changes, healthcare providers can significantly reduce the risk of complications such as catheter-related bloodstream infections, dislodgement, and site infections, thereby improving patient outcomes.