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<strong>PICC</strong> <strong>WORKSHEET</strong><br />
AFFIX PATIENT LABEL<br />
Patient’s Name: .....................................................................................................................<br />
Doctor’s Name: .....................................................................................................................<br />
<strong>PICC</strong> Insertion date: .............................................................................................................<br />
Product Number: ......................................................... Lot number: ..................................<br />
Exposed catheter length: ...................... Upper arm circumference: ..................................<br />
Chest X-ray date: .................................................... Internal length: ..................................<br />
Person inserting <strong>PICC</strong> - Name: ...........................................................................................<br />
and Signature: ...........................................................................................<br />
AFFIX <strong>PICC</strong> INSERTION STICKER OR COMPLETE<br />
Brand of <strong>PICC</strong>: .................................................................. Size of <strong>PICC</strong>: ..............................................................................<br />
Location of <strong>PICC</strong>: ..................................................... Number of lumens: ..............................................................................<br />
Positive pressure bung in situ? YES NO X-ray Verified by: ..............................................................................<br />
<strong>PICC</strong> Principles of Care<br />
Newly inserted <strong>PICC</strong>s<br />
• To minimise bleeding restrict arm<br />
movement for the first 2 hours<br />
• To avoid redressing the insertion site<br />
frequently in the first 24 hours apply a<br />
pressure bandage directly over the<br />
occlusive dressing.<br />
Caps/Bungs<br />
• Access using clean technique<br />
• Changed weekly using aseptic technique<br />
• Positive pressure bung for all Arrow<br />
<strong>PICC</strong>s<br />
Flushing<br />
• In a pulsatile, (stop start) manner<br />
• With normal saline before and after<br />
access<br />
• Weekly if not in use<br />
Dressings<br />
• Changed weekly and prn if not dry<br />
and intact using aseptic technique.<br />
Syringes<br />
• No smaller than 10ml<br />
Confirmation of placement<br />
• By aspiration of blood<br />
• Ability to easily infuse solutions<br />
• Normal appearance of <strong>PICC</strong> site and<br />
patient’s arm<br />
• Measurement of <strong>PICC</strong> length from<br />
insertion site to catheter hub.<br />
Clamps<br />
• Must be left open when a positive<br />
pressure bung is in use<br />
Source: GONG Cancer Care Guidelines (2005) <strong>PICC</strong> Management Guidelines pp1-6
NAME: .............................................................................................................. UR: ..............................................................<br />
Date &<br />
Time<br />
Stat Lock<br />
changed<br />
Positive<br />
Pressure<br />
Bung/cap<br />
changed<br />
Blood<br />
return<br />
obtained<br />
Dressing<br />
reviewed/<br />
attended<br />
External<br />
length from<br />
insertion<br />
point to hub<br />
measured<br />
Complications<br />
or interventions<br />
Signature<br />
Designation<br />
2
NAME: .............................................................................................................. UR: ..............................................................<br />
Date &<br />
Time<br />
Stat Lock<br />
changed<br />
Positive<br />
Pressure<br />
Bung/cap<br />
changed<br />
Blood<br />
return<br />
obtained<br />
Dressing<br />
reviewed/<br />
attended<br />
External<br />
length from<br />
insertion<br />
point to hub<br />
measured<br />
Complications<br />
or interventions<br />
Signature<br />
Designation<br />
3
NAME: .............................................................................................................. UR: ..............................................................<br />
Date &<br />
Time<br />
Stat Lock<br />
changed<br />
Positive<br />
Pressure<br />
Bung/cap<br />
changed<br />
Blood<br />
return<br />
obtained<br />
Dressing<br />
reviewed/<br />
attended<br />
External<br />
length from<br />
insertion<br />
point to hub<br />
measured<br />
Complications<br />
or interventions<br />
Signature<br />
Designation<br />
4
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