Discharge Instructions: Changing the Dressing on Your Peripherally Inserted Central Catheter (PICC)
You are going home with a peripherally inserted central catheter (PICC). This small, soft tube has been placed in a vein in your arm. Where the catheter enters your body, it’s covered with a bandage (dressing). The bandage is often made of clear (transparent) plastic. This helps keep the area free of germs. To prevent infection, you need to keep the dressing clean and dry. Only change the dressing if you or a caregiver have been told to do so. This sheet explains the process. Also follow any specific instructions you get from your healthcare provider.
Prevent infection with good hand hygiene
A PICC can let germs into your body. This can lead to serious and sometimes deadly infections. To prevent infection, it’s very important that you, your caregivers, and others around you use good hand hygiene. This means washing your hands well with soap and water, and cleaning them with an alcohol-based hand gel as directed. Never touch the PICC or dressing without first using one of these methods.
To wash your hands with soap and water:
Wet your hands with warm water. (Avoid hot water. It can cause skin irritation when you wash your hands often.)
Apply enough soap to cover the whole surface of your hands, including your fingers.
Rub your hands together vigorously for at least 15 seconds. Make sure to rub the front and back of each hand up to the wrist, your fingers and fingernails, between the fingers, and each thumb.
Rinse your hands with warm water.
Dry your hands completely with a new, unused paper towel. Don’t use a cloth towel or other reusable towel. These can harbor germs.
Use the paper towel to turn off the faucet, then throw it away. If you’re in a bathroom, also use a paper towel to open the door instead of touching the handle.
When you don’t have access to soap and water: Use an alcohol-based hand gel to clean your hands. The gel should have at least 60% alcohol. Follow the instructions on the package. Your health care team can answer any questions you have about when to use hand gel, or when it’s better to wash with soap and water.
When to change the dressing
If you have a transparent dressing, change it every 7 days (or more often if instructed).
If you have a gauze dressing, change it every 2 days. This includes gauze under a transparent dressing.
If the dressing becomes loose, dirty, or wet, change it right away. Report this to your healthcare provider as soon as possible.
Avoiding infection while changing the dressing
The PICC provides a direct path into your bloodstream. So the chance of infection is high as you change the dressing. Don’t touch the catheter where it enters the skin. And be very careful to keep your work area and supplies clean. Following the steps on this sheet will help. Keep in mind that some supplies come in germ-free (sterile) packaging. Make sure to keep these sterile during the dressing change.
Supplies for changing the dressing
A general list of supplies is below. Your health care team will provide you with a list of specific items and brands to use. Or you may get a kit that has everything you need. Your supplies may include:
Antimicrobial sponge disc
Antiseptic supplies to clean the skin and around the catheter exit site (such as chlorhexidine plus alcohol)
Non-sterile gloves and a mask
Medical tape, adhesive strips, or a securement device
Before you start, review the steps below and make sure you understand them. If you’re not sure what to do or how to use your supplies, ask a member of your healthcare team before you try to change the dressing.
Note: Since the PICC is in your arm, you’ll only have one free arm during the dressing change. This makes it very hard to change the dressing yourself. Have someone available to help you.
Step 1. Wash your hands
Wash your hands well with soap and water. Use the method described above.
Step 2. Prepare your work area
Choose an area with a hard, flat surface where you can easily spread out the supplies, such as a desk or table. Don’t use the bathroom; there are too many germs.
Put pets and children out of the work area. Keep them out until the dressing change is done.
Clean washable surfaces with soap and water. Dry with a clean, unused paper towel. Then throw the paper towel away.
Spread clean, unused paper towels over your work surface. Use as many as you need to cover it.
If you need to cough or sneeze, move away from your work surface first.
Step 3. Lay out your supplies
Clean your hands with soap and water or hand gel. Do this before you lay out your supplies on the work surface.
After cleaning your hands, only touch your supplies. If you do touch anything else, such as furniture or your clothes, wash your hands again. This is very important for preventing infection.
Place your supplies on the cleaned and dried work surface. Lay them out in the order you will be using them.
If you’re using a kit with a sterile tray, take off the plastic covering. Remove the covering only. Don’t open the tray. Keep the plastic covering. You can use it to dispose of the old dressing.
Step 4. Remove the old dressing
Put on clean gloves and a mask. Anyone who is helping you change the dressing should do this, too. (Don’t use sterile gloves for this step. Sterile gloves are used in Step 5.)
Take off the old dressing by gently pulling the edges. Carefully peel off the dressing in the direction of the catheter site. While doing this, hold the end of the catheter (lumen) so it doesn’t pull out of your body.
If a securement device is in place, carefully remove it using the method your nurse showed you.
Check the catheter site for signs of infection such as redness, swelling, drainage, or a bad odor. If you notice any, call your healthcare team when you’re finished changing the dressing.
Wrap the old dressing in plastic (if available) and put it aside.
Step 5. Prepare sterile supplies
Remove your gloves and clean your hands with hand gel. You should still be wearing the mask.
Open any sterile supplies, such as the transparent dressing and sterile gloves. Follow the directions on the package or your healthcare team’s instructions.
Put on sterile gloves. Follow the directions on the package or as you were shown in the hospital.
Step 6. Clean the catheter site
If the skin under the dressing has dried blood or a lot of drainage, clean it as directed by your healthcare team.
Clean the catheter exit site using the antiseptic supplies your healthcare team recommends. It’s very important to follow the package directions and your provider’s instructions exactly.
Step 7. Apply the new dressing
If you’re using a securement device, apply it as you were shown. This may be skipped if you have stitches holding the PICC in place. (Be sure to report any loose stitches to your healthcare provider.)
If you’re using a gauze dressing, apply it over the catheter exit site the way your nurse showed you.
If you’re using an antimicrobial sponge disc, place it around the catheter with the correct side touching your skin. Line up the slit on the sponge disc with the catheter.
Apply the transparent dressing over the catheter exit site and over the gauze or sponge disc (if used). Put the top end down first. Then smooth out the rest across the area where the catheter exits your skin. Make sure the dressing covers the entire catheter.
Take off and discard the sterile gloves and mask.
Tape the end of the catheter (lumen) to your skin, as directed by your healthcare provider.
Throw away the old dressing and used supplies.
Wash your hands.
Changing the injection caps
The catheter’s injection caps need to be changed every 3 to 7 days. This is often done at the same time as the dressing change. Your healthcare provider will give you instructions.
Risk of blood clot
If a blood clot forms, it can block blood flow through the vein where the catheter was placed. Signs of a blood clot include pain or swelling in your neck, face, chest, or arm. If you have any of these symptoms, call your healthcare provider right away. You may need an ultrasound exam to locate the blood clot and be treated with a blood thinner.
When to seek medical care
Call your healthcare provider right away if you have any of the following:
Pain or swelling in your shoulder, chest, back, arm, or leg
Fever of 100.4°F (38.0°C) or higher
Signs of infection at the catheter site (pain, redness, drainage, burning, or stinging)
Coughing, wheezing, or shortness of breath
A racing or irregular heartbeat
Muscle stiffness or trouble moving
Gurgling noises coming from the catheter
The catheter falls out, breaks, cracks, leaks, or has other damage
March 21, 2017
Mancini, Mary, MD,Ziegler, Olivia, MS, PA