today we are doing a picc dressing now remember that these tutorials are simply
only informational and you always need to be checking with your agency's policy
to make sure you're following the guidelines for your patient population
now let's get to the lab welcome back my name is Tammy and this is nurse minder
and on this channel we do everything nursing so if you're new here consider
subscribing below so that you get the next video when it's released so we're
going to look next up PICC dressings and the first thing we need to do is to make
sure my surface is clean so we need to cavi wipe the table that we're going
to be putting our supplies on you always want to wear gloves with the cavi wipe
because they are toxic remove all your patients belongings to their bedside
table and give it a good clean and let it dry next I'm going to gather my
supplies and I'll bring them back so I have all of our supplies I'm going to go
over them for you so you know what to gather I need clean pair of gloves to
take off the old dressing I need a mask for me and a mask for my patient because
this is a long procedure and they sometimes like to talk a lot with us so
I want to give them a mask so they're not breathing on that area as well I
have a sterile dressing tray you can do it with or without I will demonstrate
both ways in this video I have my measuring tape to make sure that I have
the correct length of my PICC line both pre and post I have a clean two by two
or sterile two by two sorry so that I can hold my line if I choose not to use
my dressing tray then I need to still grab a sterile two by two my stat lock
which is what this PICC line comes with you may also find in your facility they
have securacaths those do not get removed they stay there three four chlorhexadine
swabs my advanced Tegaderm have alcohol swabs to remove the current
stat lock that's there and of course my
sterile gloves so before we get started the first thing we're going to do after
hand hygiene and patient conversation and explanation is to put on our masks
and then of course the mask of our patient as well and I'm gonna get my
tray set up so that it's within arms reach so I'm just going ahead and I'm opening my
chlorhexadine swabs here they do have a nice little fold here so you can pull it
down without touching it to keep it sterile I'm gonna be using those first
if you were to open up your sterile dressing tray at this point the items
that you would be putting on it would be your Tegaderm your statlok and you have
sterile dressings in there so in fact I'm going to open this in case I need a
sterile dressing to help take off I'm gonna put on my clean gloves and then
we're gonna start to look at this picc line with every assessment we can take a
look at the site to make sure that there's no irritation swelling edema we
can ask our patient if there's any pain we're going to do a measurement to make
sure so at 13 centimeters that when we're done we're also at 13 centimeters
one of the first things I'm going to need are my alcohol swabs and my clean
gloves so we're going to start by taking off this dressing
now tegaderms are meant to loosen by pulling sideways on them so if you just
pull laterally on them it does lift off the glue so inside our stat lock is
actually a piece of tape and I'm gonna go ahead and grab that out the rest will
stay in there and if you're using this it's just to secure the line so that it
doesn't move on you and I'm going to just insert this right here the next
thing I want to do is actually remove this and this is still a clean procedure
but I'm gonna need alcohol swabs to loosen the glue that's on my mannequin
or on my patient sorry so that this lifts up easily and
sometimes you need to lift it and alcohol swab underneath to get that glue
to come unstuck this one's still pretty sticky so I'm going to do a lot more on
top here and now we see it starting to lift
now we need to do the other side so now that we have this all this and it's able
to leave the skin one need to open these clamps here and lift our line up and
then remove our dressing so at this point now we need to clean it now we can
still use our clean gloves or you can choose to put on your sterile gloves at
this time if you've put your content in your sterile dressing so at this time
I'm still using a clean procedure and I'm now gonna do my cleaning I'm gonna
grab my first chlorhexidine swab this is the tip that I want to keep away from my
clean gloves we're gonna start with doing broad
strokes up and down back and forth make this nice and wide because my dressing
is large and the friction is just as important as the motion 15 seconds and
then we're going to flip the sponge over ankle in a back-and-forth motion for
again 15 seconds and nice broad strokes here we want to make sure the friction
and the chlorhexidine is getting on our patients skin so this one is used just
for the upper half of the arm and now we're finished with this one that can be
discarded I'm going to grab our second chlorhexidine swab again making sure
we're only touching the handle and now we're going to do the lower half doing
the exact same thing this may be a place where you want to hold on to your line
and lift it up to secure it so we're gonna start up and down big broad
strokes
again we do this for 15 seconds there's a bit of tape residue here now we're
going to flip it over and go in the opposite direction
for 15 seconds now the final chlorhexidine swab is for underneath the
line so here's what I'm going to use my sterile 2x2 to support the line so I
don't accidentally pull it out and clean underneath and then *without flipping it
over* (use untouched side) and clean on top make sure you get nice in those areas here where it might
be a bit gunky and I can lift off my gauze and clean the rest of the line we
let that dry and this might take two minutes to dry so this is a good time to
get sterile if you're not already so I brought my sterile field over so you can
see a little bit more closely related to the picc dressing now at this point in
time we want to put our skin prep on and this is just going to go around the
entire everything is dry now so we're going to just put skin prep around the
entire thing and remember this is sterile it came in my sterile kit so
this is gonna get tacky and you'll know that it's ready to go because my gloves
are starting to stick together so the tackiness is there so we're gonna take
our stat lock first arrows point it towards the insertion site and we're
going to slip this in and secure this I
just remind you that these are sterile gloves so I can touch the sterile field
in which I've cleaned and I'm working in
close off these clamps
closed off these clamps and secure
so now my picc line is secure I'm going to take my tegaderm and we want this
insertion site to have a nice window of Tegaderm around it so we're going to put
this loosely over top so that it's about in the center if we can I'm just going
to move my line over a bit there we go
and then smooth down our edges I can take off this holding tape now and we
still have two tapes left to apply we have the large secure tape and then the
date tape when working with the IV advance Tegaderm your large secure tape
will then be placed on top of your original dressing such that the use will
line up for the opening and it will secure your catheter in place the date
tape is then filled out and applied along the white border of your dressing
if in your facility you are using a different dressing you may be placing
the large secure tape underneath the IV catheter lines to secure it with the
u-shape pointing up and the dressing date tape may in fact be used on top of
those lines to further secure last but not least we're going to redo our
measurement to ensure the post dressing measurement is the same as our pre
dressing measurement there you have it your dressing all taken care of now make
sure you're always gathering your supplies cleaning that station before
you start and you're getting your patients consent if possible until next
time make it a great day