From the Guidelines
A Neonatal Intensive Care Unit (NICU) should have staff available around the clock who are trained and competent to change Peripherally Inserted Central Catheter (PICC) dressings. This is essential for patient safety and optimal care of critically ill neonates. PICC lines are vital for administering medications, fluids, and nutrition to vulnerable infants, and proper maintenance of these lines is crucial to prevent complications such as infection, dislodgement, or occlusion. According to the most recent and highest quality study, there is no clear difference between gauze and tape and polyurethane dressings on the incidence of CRBSI 1. However, it is recommended that dressings should be changed every 2 days for gauze dressing, and every seven days for transparent dressing, or sooner if the dressing becomes damp, loosened, or soiled 1.
The staff responsible for PICC dressing changes should be specifically trained in aseptic technique and the unique considerations for neonatal patients, including skin fragility and size-appropriate materials. This typically includes neonatal nurse practitioners, specialized NICU nurses, or physicians with appropriate training. Having this capability available 24/7 aligns with best practices for infection prevention and maintenance of central lines in the high-risk NICU population.
Some key points to consider when changing PICC dressings in a NICU setting include:
- Using sterile gauze with tape or transparent semi-permeable polyurethane dressing to cover the catheter insertion site 1
- Changing dressings every 2 days for gauze dressing, and every seven days for transparent dressing, or sooner if necessary 1
- Considering the use of chlorhexidine-impregnated dressings in patients older than two months with short-term catheters who are at high risk for infection 1
- Ensuring that staff are trained in aseptic technique and the unique considerations for neonatal patients 1
Overall, having staff available around the clock to change PICC dressings is crucial for preventing complications and ensuring the best possible outcomes for critically ill neonates.
From the Research
NICU Staffing for PICC Dressing Changes
- The presence of staff around the clock who can change a PICC dressing is crucial for minimizing the risk of complications such as dislodgement, migration, and infection 2.
- A properly applied and maintained PICC dressing is the first line of defense against these complications, highlighting the importance of having trained staff available at all times 2.
- While the provided studies do not directly address the issue of NICU staffing for PICC dressing changes, they emphasize the importance of proper PICC maintenance and the need for guidelines to reduce complications 2, 3, 4, 5, 6.
Importance of Proper PICC Maintenance
- The studies focus on the reduction of vancomycin use in NICUs and the implementation of antibiotic stewardship programs 3, 4, 5, 6.
- However, the underlying theme of preventing infections and complications related to PICC lines supports the idea that having staff available to change PICC dressings is essential for patient care 2.
- The reduction of vancomycin use and the implementation of antibiotic stewardship programs can be seen as complementary to the goal of minimizing PICC-related complications, emphasizing the need for a comprehensive approach to NICU care 3, 4, 5, 6.