As a former PICC nurse, several years ago, I am asked sometimes to remove a PICC line when a pt. is being discharged. I work nights and the PICC team is not available. Is it still the correct procedure to have the pt. perform the Valsalva manuver and to use a vaseline gauze drsg. and a 4x4 with a tegaderm drsg. I also wear a mask, use sterile gloves, and clean the area with chlorahexidine first. If the standards have changed in the past few years could someone let me know the new technique. Thanks in advance!
I don't wear a mask or use sterile gloves. I don't clean with CHG first. I don't think that these are indicated in a standard of care. Am I wrong?
I also question using vaseline gauze. I don't think there is a documented case of air embolism with a PICC removal. We would have heard about it in a publicatoin by now. The site always bleeds with a removal. OK, I can see that if the patient was in a very contorted position that it "might" allow air into the site, but not the normal position during a removal.
All of the studies that discuss air embolism associated with CVC removal are related to chest placed or IJ placed CVCs. The INS standard ranks this higher than I think necessary, since none of the studies referenced are about PICCs. JUst my opinion.
Gwen Irwin
Gwen, you are correct that there has not been an air embolism documented from a PICC removal. However, there still remains a theorectical possibility that it can happen. I have spoke with nurses who verbally report seeing this happen, so I do not believe that if it were happening we would have a publication about it. This would only be a case report because there is not way to ethically conduct a study on this. We know from other case reports that the fibrin sheath can remain intact and connected to the skin-to-vein tract after catheter removal. Although the PICC is longer, it is still very possible for this to remain intact. If the patient is sligthly dehydrated, stands up and takes a deep breath, air can be pulled into this tract. So I strongly disagree with your approach. I also think that the highest level of infection prevention should be provided for all procedures. This is now the focus of a group from the UK called Association for Safe Aseptic Practices. So masks, gloves, cleaning, etc are important. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I do the same. Sterile gloves, mask, site care just like I use when doing a dressing change because it is an open vessel that I want to keep bacreria out of as well as air. I use the sterile gauze from the dressing change kit and apply sterile petrolium from a single use package, cover with the tegaderm from the kit as well. I guess I would rather erre on the side of caution and think about "if it were my body" what would I expect? Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC