Hi all,
I am in home health and I am being trained to remove PICC lines and I have some questions. I have not done one yet as I am confused about proper procedure and everyone seems to do it different. I am in school getting my BSN and I have access to Hospital procedures for many different nursing skills. When removing PICC in the hospital it says place the patient in a position where the level of the cath is below the heart. Since I am in home health that is not always possible should I place them in a supine position or can this be done in a sitting position. What is the best position?
Also before you remove, ask the patient to take a deep breath in and hold it (Valsalva response) unless ontraindicated, patient should be asked to exhale during removal.
Anyway no way I am doing this untill I know I am being trained properly, I have talked three different nurses all who have many years of experience but not getting consistant answers.
Thanks
Kim
Place the aWrm so that the PICC exit site is at or below the level of the heart, but this is relatively easy to do with a PICC. The patient in a recliner or lying on a sofa will work. Remove the dressing and stabilization deivce, then withdraw short segments of the catheter slowly. If you meet resistance always STOP! When the catheter tip is near the puncture site, either ask the patient to perform a Valsalva OR hold their breath. Both are not required. Then withdraw the rest of the catheter and hold pressure on the site until bleeding has stopped. Then place an occlusive dressing - gauze with ointment or Vaseline gauze over the site. Air emboli is unlikely with a PICC insertion site, but it is possible.
If you met resistance, allow time because this is probably due to venospasm. Time is usually all that is required, but it could be stubborn. There are other techniques if the resistance continues - heat application, drinking warm liquids and vasodilating medications. But the key is never apply force when withdrawing.
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 am the Infusion Specialist for a hospital based Home Infusion company. I have trained all my Home Care and Hospice RN's to remove PICCs in the home, doing as Lynn states. We have had no complications. We also declot in the home without problems. I know some agencies won't do this but it is a safe practice.