The nursing implications include not only monitoring for complications but ensuring the PICC line functions well. The first point to make is that the PICC cannot be used without an order saying it is safe to use. In order for this to happen, there needs to be an x-ray for confirmation of placement. The only exception to this is if the PICC was placed using 3cg technology; when this is done, there will still be proof of the catheter being okay to use, and the accompanying order will follow.
There may be problems in using the line due to issues with line clots or problems aspirating blood from the PICC, such as is the case in our second scenario. The answer to this, of course, is getting rid of the clot. If a line clot is suspected, the nurse can obtain an order for a clot-busting medication such as streptokinase, use per facility policy instructions. If the nurse if having trouble aspirating blood and a clot is not suspected, the catheter may be against the vessel wall; a change in patient position may help. To prevent blood clotting, ensure the patient has adequate hydration and that the line is flushed regularly according to facility policy.
Removal of the PICC line should be done by someone trained in performing this practice. The most important thing to know about this is that upon removal of the line, the line itself needs to be measured and compared with the documented insertion length. If there is a shortage of length in the catheter, the patients’ attending provider has to be contacted at once, and a STAT chest x-ray is ordered and performed.
In performing patient education, it is important to include not only the patient but also the caregivers of the patient as well. Patient education includes not only sterile dressing changes but also proper flushing techniques, signs and symptoms of complications as well as daily care of the PICC. It is now the norm for the patient to go home with a PICC line, so the long term education with documentation thereof is very important.