Peripherally inserted central catheter (PICC)

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• 10ml luer lock syringe (x1 per lumen)
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• X2 21g safety hypodermic needle or 18G blunt filter needle
• Catheter lock (if required)
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Curos cap (disinfection cap) (x1 per lumen)
• Clinical waste bag
• Sharps bin.

Flush and lock of catheter should be carried out every 7 days.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Apply PPE.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin protect tip of syringe by placing onto sterile field or by placing in Micro Critical Field (sterile syringe packet).
• Observe the external length of the PICC, from the exit site to the start of the hub.
• Ensure PICC is clamped.
• ‘Scrub the hub’ threads with the 2% chlorhexidine in 70% isopropyl alcohol wipe for 30 seconds. Allow to dry.
• If removing lock – using ANTT, attach an empty 10ml syringe, unclamp and gently aspirate 2-5mls of blood from the PICC. Reapply clamp and discard syringe.
• Check with child’s care plan whether the PICC line can be aspirated/achieve flashback.
• Using ANTT, attach 10ml syringe filled with 0.9% NaCl, unclamp, pull back to ensure flashback is achieved (if appropriate), flush the catheter using a push/pause technique, maintaining positive pressure on the plunger of the syringe. Reapply clamp and detach syringe. Never flush if resistance felt.
• If lock is being used then administer lock following previous step. Check if lock is required in the child’s care plan.
• Apply curos caps to each lumen after use.
• Repeat for each lumen if required.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

• Record procedure and complete CVAD bundle.
• Ensure VAD is positioned correctly to ensure skin health is maintained.

• PPE (minimal consideration disposable apron and gloves)
• Sterile gloves
• Clean tray or trolley
• Sterile dressing pack
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Sterile chlorhexidine impregnated patch
• Sterile semi permeable transparent dressing
• Catheter securing device e.g. Statlock, Griplock, steri-strips or equivalent
• Medical adhesive remover (if required)
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag.

The catheter securing device should be changed every 7 days.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Discard gloves and apply sterile gloves.
• Place the sterile drape under the CVAD to create a sterile field.
• Observe the external length of the PICC, from the exit site to the start of the hub.  
• Carefully remove the catheter securing device.
• Whilst holding the catheter with a sterile swab, clean the exit site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/ wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Apply catheter securing device to the PICC. DO NOT PLACE OVER THE EXIT SITE.
• Cover exit site with sterile chlorhexidine impregnated patch ensuring the arrows are aligned correctly. Apply sterile semi permeable dressing, ensuring that the catheter is covered with the dressing and good adherence to the skin.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• Sterile gloves
• Sterile dressing pack
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Sterile chlorhexidine impregnated patch
• Sterile semi permeable transparent dressing 
• Medical adhesive remover can be used here to aid in the removal of the dressing
• Catheter securing device e.g. Statlock, Griplock, steri-strips or equivalent
• NFAD (x1 per lumen)
• 10ml luer lock syringe (x1 per lumen)
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• X2 21g safety hypodermic needle or 18G blunt filter needle
• Catheter lock (if required)
• Curos cap (disinfection cap) (x1 per lumen)
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag
• Sharps bin.

The catheter securing device and NFAD should be changed every 7 days.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin protect tip of syringe by placing onto sterile field or by placing in Micro Critical Field (sterile syringe packet) and place to the side.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Stop all fluids being infused via the PICC (if applicable)
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Discard gloves and apply sterile gloves.
• Place the sterile drape under the CVAD to create a sterile field.
• Observe the external length of the PICC, from the exit site to the start of the hub.  
• Carefully remove catheter securing device.
• Whilst holding the catheter with a sterile swab, clean the exit site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Apply catheter securing device to the PICC. DO NOT PLACE OVER THE EXIT SITE.
• Cover exit site with sterile chlorhexidine impregnated patch ensuring the arrows are aligned correctly. Apply sterile semi permeable dressing, ensuring that the catheter is covered with the dressing and good adherence to the skin.
• Ensure PICC is clamped.
• Remove needle free access device and discard. ‘Scrub the hub’ threads with the 2% chlorhexidine in 70% isopropyl alcohol wipe for 30 seconds. Allow to dry. Apply primed needle free access device.
• If removing lock – using ANTT, attach an empty 10ml syringe, unclamp and gently aspirate 2-5mls of blood from the PICC. Reapply clamp and discard syringe.
• Check with child’s care plan whether the PICC line can be aspirated or achieve flashback.
• Using ANTT, attach 10ml syringe filled with 0.9% NaCl, unclamp, pull back to ensure flashback is achieved (if appropriate), flush the catheter using a push/pause technique, maintaining positive pressure on the plunger of the syringe. Reapply clamp and detach syringe. Never flush if resistance felt.
• If lock is being used then administer lock following previous step. Check if lock is required in child’s care plan.
• Apply curos caps to lumen after use.
• Repeat procedure for all lumens.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• Sterile gauze swabs
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Sterile adhesive dressing (check allergies)
• Medical adhesive remover (if required)
• Clinical waste bag.

• Assess patients bleeding risk and if they are either therapeutically anticoagulated or have an abnormal clotting screen seek advice from patient’s consultant prior to removal.
• Explain the process to the child and parent and gain consent.
• Ensure patient is positioned with arm lower than the level of the heart during removal.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Stop all fluids being infused via the PICC (if applicable)
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Replace gloves if contaminated with body fluids.
• Using ANTT, clean around the insertion site with 2% chlorhexidine in 70% isopropyl alcohol.
• Hold a piece of dry cotton gauze over the insertion site and remove the PICC in a slow and steady motion.
• If resistance is felt, seek advice.
• Apply firm pressure immediately to insertion site until haemostasis is achieved.
• After removal the PICC should be inspected for integrity, length and damage.
• Apply sterile adhesive dressing to the insertion site, checking for any allergies.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle

Observe PICC site for signs of infection, bleeding and bruising.