Proper Procedure for Changing a PICC Dressing

Preparation and Hand Hygiene

The American College of Radiology recommends hand hygiene procedures, including washing hands with conventional soap and water or alcohol-based hand rubs, must be performed before and after all catheter-related interventions 3, 4
Maximal sterile barrier precautions, including cap, mask, sterile gown, sterile gloves, and a sterile drape, should be used for dressing changes, as recommended by Clinical Nutrition 1, 3

The American College of Cardiology and Clinical Infectious Diseases recommend preparing the skin with a 0.5-2% chlorhexidine preparation with alcohol (2% chlorhexidine gluconate in 70% isopropyl alcohol is preferred) 1, 2, 5
If there is a contraindication to chlorhexidine, alternatives such as tincture of iodine, an iodophor, or 70% alcohol may be used, as suggested by Clinical Infectious Diseases and Clinical Nutrition 2, 5

Sterile gauze or sterile, transparent, semi-permeable dressings should be used to cover the catheter site, as recommended by Clinical Infectious Diseases and Clinical Nutrition 2, 6
For the first 1-2 days after insertion, placement of sterile gauze between the PICC entry site and adhesive dressing is appropriate, according to Annals of Internal Medicine 7, 8

Gauze dressings should be replaced every 2 days for short-term CVCs, as recommended by Clinical Infectious Diseases and Clinical Nutrition 2, 10
Transparent dressings should be replaced at least every 7 days, according to Clinical Infectious Diseases and Clinical Nutrition 2, 10

Manufactured catheter stabilization devices should be used rather than sutures to secure the catheter whenever feasible, as recommended by Clinical Nutrition 1

Topical antibiotic ointment or creams should not be applied on insertion sites, as they may promote fungal infections and antimicrobial resistance, according to Clinical Infectious Diseases and Clinical Nutrition 2, 6
Chlorhexidine-impregnated dressings may be considered for patients with short-term catheters who are at high risk for infection, as suggested by Clinical Infectious Diseases and Clinical Nutrition 2, 10

The catheter or catheter site should never be submerged in water, and showering may be permitted with appropriate precautions, according to Clinical Infectious Diseases 2
Organic solvents (e.g., acetone, ether) should not be used on the skin before or after applying antiseptic, as recommended by Clinical Nutrition 1
A migrated PICC should never be advanced, and guidewire exchange is the appropriate approach if the PICC needs to remain in place, according to Annals of Internal Medicine 8, 9
Daily skin cleansing with a 2% chlorhexidine-impregnated wash cloth may help reduce the risk of catheter-related bloodstream infections, as suggested by the Journal of the American College of Radiology 3, 4