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