HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 9-9
Infusion Therapy: Peripherally Inserted Central Catheter (PICC) Insertions __RN
Gloves, sterile (2 pair)
Waterproof gown
Protective eye wear
Mask (2)
Puncture-proof container
Biohazard trash bag
PROCEDURE:
1. Adhere to Universal Precautions.
2. Explain procedure and purpose to patient/caregiver.
3. Wash hands and assemble equipment on a clean
surface, close to the patient.
4. Place patient in comfortable position making sure
that site is accessible.
5. Ensure adequate lighting.
6. Apply tourniquet 4" above the antecubital fossa and
identify appropriate venous access insertion site.
The basilic vein is recommended for cannulation.
Mark insertion site, then release tourniquet. Leave
tourniquet under patient's arm.
7. With a tape measure, measure the distance from
the insertion site to proposed catheter tip placement
site.
a. Superior vena cava placement (PICC): Measure
from the point of insertion along the vein tract to
the shoulder and across the shoulder to the
sternal notch and down 3 intercostal spaces.
b. Flush catheter with 0.9 % sodium chloride,
injection, before insertion to confirm catheter
patency.
8. Position patient for insertion with arm extended at a
45-degree angle to the trunk. Instruct patient to turn
his/her head toward the arm of insertion with chin
touching the clavicle.
9. Put on mask, gown and protective eye wear (if
indicated). Assist patient with putting on a mask (if
indicated).
10. Open catheter kit and place all supplies on the
sterile field.
11. Don sterile gloves.
12. Spread out sterile non-fenestrated drape and have
patient position arm on top of sterile drape.
13. Using sterile techniques, clean insertion site
vigorously with alcohol applicator three times, use a
circular motion, starting from the center moving
toward periphery. Allow to air dry. Repeat this
procedure using three antimicrobial applicators and
allow to air dry. DO NOT BLOT. If using 2%
chlorhexidine solution to disinfect site then it is not
necessary to use povidone-iodine after alcohol prep.
Also not necessary to cleanse site in a circular
fashion, can use back and forth motion across
intended insertion site. Allow to air dry, DO NOT
BLOT.
14. Prepare the remaining catheter insertion materials.
a. Spread out second sterile non-fenestrated
drape.
b. Grasp catheter while holding the guidewire and
lay out on sterile field. Use forceps or
powderless gloves to handle the catheter.
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