Bard Access Systems, Inc.

How to Care For Your

Patient Guide

Page

Introduction

1. WhatisaPowerPICC SOLO* Catheter.............................. 1

2. HowDoestheValveWork?.................................................. 2

3. WhatisthePICCUsedFor?................................................ 3

4. WhereDoesthePICCGoInsidetheBody?........................ 3

5. WhatisRequiredtoTakeCareofthePICC?....................... 4

a.SiteCare........................................................................ 5

b.ClampingThePICC......................................................... 8

c.FlushingThePICC.......................................................... 9

d.ChangingTheInjectionCap.......................................... 11

e.BeAbleToDetectProblemsAndKnowWhatToDo............. 13

6. QuestionsOtherPatientsHaveAsked............................... 17

7. Quiz/Answers................................................................ 24-25

8. CatheterInformationandSupplyList................................. 27

9. AcknowledgementCard..................................................... 28

Table of Contents

www.bardaccess.com www.powerpiccsolo.com

Catheter Hub

Extension Leg

Junction

Reverse Taper

PICC

Reverse Taper

PICCisashortnamefor“PeripherallyInsertedCentralCatheter”,reflectingthefactthatthecatheterisinsertedintoalargeveininyourarm(usuallythebasilicorcephalicvein).Unlikemostcatheters,thePowerPICC SOLO* catheterhasavalvethatallowsliquidstoflowinoroutbutitremainsclosedwhenitisnotinuse.ThePowerPICC SOLO* cathetermayalsobeusedforcontrastpowerinjectionsatupto5ml/sec.

What is a PowerPICC SOLO* Catheter?

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New Important Information:RecommendedFlushing/MaintenanceProcedure(s)

Thecathetershouldbemaintainedinaccordancewithstandardhospitalproto-cols.Recommendedcatheterflushing/maintenanceisasfollows:

1.Flushthecatheteraftereveryuse,oratleastweeklywhennotinuse.Usea10mlorlargersyringe.2.Flushthecatheterwithaminimumof10mlof0.9%sodiumchloride,usinga“pulse”or“stop/start”technique.Useofheparinizedsalinetolockeachlumenofthecatheterisoptional.3.Disconnectthesyringeandattachasterileendcaptothecatheterhubandtightensecurely.4.PriortobloodsamplingwheninfusingTotalparenteralnutrition(TPN),followroutinemaintenanceprocedureexceptuse20mlsalineandflushtoclearTPNfromthecatheter.5.Ifresistanceismetwhenflushing,nofurtherattemptsshouldbemade.Furtherflushingcouldresultincatheterrupturewithpossibleembolization.Refertoinstitutionprotocolforclearingoccludedcatheters.

NOTE:Wheninjectingorinfusingmedicationsthatareincompatible,youshouldalwaysflushthecatheterwithaminimumof10mlsalinebeforeandaftereachmedication.

NOTE:Whenmaintainedinaccordancewiththeseinstructions,thePowerPICC SOLO*catheterdoesnotrequiretheuseofheparinizedsalinetolockthecatheterlumens.However,useofheparinizedsalinewillnotadverselyeffectthecatheterandmaybenecessarybasedonpatientstatusoruseofalternateflushingandlockingtechniques.

Caution:Alwaysremoveneedlesorneedlelesscapsslowlywhileinjectingthelast0.5mlofsaline.

Caution:Useaseptictechniqueswheneverthecatheterlumenisopenedorconnectedtootherdevices.

Caution:ThePowerPICC SOLO*catheterisdesignedforusewithaneedle-lessinjectioncapsor“direct-to-hub”connectiontechnique.Applyasterileendcaponthecatheterhubtopreventcontaminationwhennotinuse.Use of a needle longer than 1.6 cm (0.625 in.) may cause damage to the valve.

Warning:Alcoholshouldnotbeusedtolock,soakordeclotpolyurethanePICCsbecausealcoholisknowntodegradepolyurethanecathetersovertimewithrepeatedandprolongedexposure.

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How does the valve work?

Power Injection Procedure1. Removetheinjection/needlelesscapfromthePowerPICC SOLO*

catheter.2. Attacha10mlorlargersyringefilledwithsterilenormalsaline.3. Aspirateforadequatebloodreturnandvigorouslyflushthecatheter

withthefull10mlofsterilenormalsaline. Warning:Failuretoensurepatencyofthecatheterpriortopower

injectionstudiesmayresultincatheterfailure.4. Detachsyringe.5. AttachthepowerinjectiondevicetothePowerPICC SOLO*catheter

permanufacturer’srecommendations.6. Contrastmediashouldbewarmedtobodytemperaturepriortopower

injection. Warning:Failuretowarmcontrastmediatobodytemperaturepriorto

powerinjectionmayresultincatheterfailure.7. Useonlylumensmarked“PowerInjectable”forpowerinjectionof

contrastmedia. Warning:Useoflumensnotmarked“PowerInjectable”forpower

injectionofcontrastmediamaycausefailureofthecatheter.8. Completepowerinjectionstudytakingcarenottoexceedtheflowrate

limits.Donotexceedthemaximumflowrateof5ml/sec. Warning:Exceedingthemaximumflowrateof5ml/sec,orthe

maximumpressureofpowerinjectorsof300psi,mayresultincatheterfailureand/orcathetertipdisplacement.

Warning:Powerinjectormachinepressurelimitingfeaturemaynotpreventover-pressurizationofanoccludedcatheter,whichmaycausecatheterfailure.

9. Disconnectthepowerinjectiondevice.10. Replacetheinjection/needlelesscaponthePowerPICC SOLO*

catheter.11. FlushthePowerPICC SOLO*catheterwith10mlofsterilenormal

saline,usinga10mlorlargersyringe.Useofheparinizedsalinetolockeachlumenofthecatheterisoptional.

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2ThePowerPICC SOLO*cathetervalvecontrolstheflowoffluidstoprovideclamp-freeinfusiontherapy.Positivepressureintothecatheter(gravity,pump,syringe)willopenthevalve,allowingfluidinfusion.Whennegativepressure(aspiration)isapplied,thevalveopensallowingforthewithdrawalofbloodintoasyringe.•Routineclampingofthecatheteroutsidethebodyisnotneeded.•Heparinisnotneededtokeepthecatheteropen.

Where does the PICC goinside the body?

What is the PICC used for?

Indicates superficialvein passing deep

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ThereareseveralusesforthePowerPICC SOLO* catheter.Itisprimarilyusedtoallowyoutohavespecialtreatmentsoveraperiodoftime.HavingthePICCwillmakeitmorecomfortableforyoubecauseyouwillnothavetohaveaneedleinsertedintoaveinoverandoveragain.

ThePICCcanbeusedtogiveyouspecialfluids,medications,bloodproducts,totakebloodsamplesfortesting,orcontrastpowerinjections.Yourdoctorornursewillexplainthereasonswhyyouhavethistypeofcatheter.

ThePICCisinsertedbythenurseordoctorintoaveininyourarmandthreadedintoalargeveinthatleadstoyourheart.

Thecatheterinsertionsitewillneedtohavespecialcare,whichwillbeexplainedlaterinthisbooklet.

CephalicVein

AccessoryCephalicVein

CephalicVein

BasilicVein

AxillaryVein

MedianCubitalVein

BasilicVein

Indicatessuperficialveinpassingdeep

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What is required to take care of the PICC?

ThereareseveralthingsthatyoumayneedtodotocareforyourPICC.

• Cleantheinsertionsiteandapplyacleandressing; • Flushthecatheter; • Changetheinjectioncap;and, • Beabletodetectproblemsandknowwhattodo whentheyoccur.

Comments and/or changes as recommended by your nurse or physician. __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

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Site Care

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Cleaningtheinsertionsiteandapplyingacleandressingisusu-allyreferredtoas“SiteCare.”SiteCareshouldbedoneonaregularbasisasorderedbyyourdoctor.Thefrequencywilldependonthetypeofdressing,yourgeneralhealth,thetypeoffluidbeinginfusedintothecatheter,andtheconditionofyourskin.Thedoctor'sordersmayalsobechangedforanyofthesereasons.

Youwillbeinstructedonhowfrequentlytochangethedressing.Youmayneedtochangethedressingdaily,threetimesaweekorweeklyorifitbecomeslooseorsoiled.Yourdoctorornursewillselectthemostappropriatesuppliesforyourroutinecare.

The“SiteCare”procedureisoutlinedhereforreference pur-poses only.Remember,youwillreceiveinstructionsfromyourdoctorornurseonallproceduresandyoushouldnotattemptanyprocedurealoneuntilyoufeelconfidentthatyoucancarryoutallofthesteps.

Supplies you will need:___ Sterilegloves___ ChloraPrep*Solution One-StepApplicator___ Sterilecoverdressing(transparentorgauze)___ Sterile2 in.x2 in.gauzedressings___ Tapestrips___ Securementdevice(ifneeded)

1. Cleantheworksurfacebywipingwithapapertowelthathasbeenmoistenedwithalcohol.Wipedryorallowtoairdry.Thenplacesuppliesonthecleanedsurface.

2. Wash your hands thoroughly using warm, soapy water. Rinsecompletelyanddryusingacleanclothtowelorfreshpapertowels.

3. Carefullyopenthedressingkit,orunwrapsupplies,withouttouchingtheinsidesurfacesofthekitsorwrappers.

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4. Carefullyremovetheolddressing,pullingawayfromthecatheterhubandtowardtheinsertionsite.Removethetapeordressingcarefullytoavoidirritatingyourskinorpullingonthecatheter.

5. Washyourhandsagain.

6. Carefullyobservetheinsertionsiteandtheskinaroundit.Lookforrednessordrainage.Measuretheexternallengthofthecathetertoensureithasnotgottenlongerorshorter.Ifyounoticerednessordrainageattheinsertionsite,haveafeverornoticethattheexternallengthofthecatheterislon-gerorshorter,finishthedressingchangeandthencallyourdoctorornurse.

7. Putonthepairofsterileglovesfollowingtheprocedureyouweretaught.Afteryouhavetheglovesonandadjusted,donottouchanythingbutthesterilesuppliesyouwillbeusingtocleantheinsertionsite.

8. CarefullycleantheinsertionsitewithaChloraPrep*SolutionOne-StepApplicator.

9. Pinchthewingsontheapplicatortobreaktheampuleandreleasetheantiseptic.Do not touch the sponge. Wetthespongebyrepeatedlypressingandreleasingthespongeagainstthetreat-mentareauntilliquidisvisibleontheskin.

10. Userepeatedbackandforthstrokesofthespongeforapproxi-mately30sec-onds.Completelywetthetreatmentareawithantiseptic.Allowtheareatodryforapproximately30seconds.Donotbloworwipeaway.

Note: Maximumtreatmentareafor1applicatorisapproxi-mately4in.x5in.Discardtheapplicatorafterasingleuse.

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11. Somefacilitiesplaceasecurementdeviceatthispoint.CheckwithyournurseordoctortoseeifthispertainstoyourPICC.

12. Folda2 in.x2 in.gauzeinhalfandplaceitunderthecath-eterhubforpadding(ifneeded),andapplytapestrips.

13. Checktoseethatthecatheterisnotkinkedorpinched.Applythecoverdressingcenteringitovertheinsertionsite,followingthedirectionsinthepackageaswellasinstruc-tionsfromyourdoctorornurse.

14. Securethecathetertothedressingorarmwithtape.Thiswillpreventpullingofthecatheterattheinsertionsiteanddecreaseirritation.Tohelppreventpossiblecatheterocclusion,coilingthecatheterisnotrecommended.

15. Alwayssecurethe catheterinsuchawaythatyoucaneas-ilyseethecapend.Yourdoctorornursewillhelpyouselectthebestmethodtosecurethecatheter.Thetypeofclothingandnormalactiv-itywillneedtobeconsideredinthisprocedure.Youshouldperiodicallylookatthecappedendtobesureitisintact.

Comments and/or changes as recommended by your nurse or physician.

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

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Clamping the PICC

Undernormalcircumstances,yourPICCwillnotneedtobeclamped.Ifdamagetothecatheteroccurs,thecathetershouldbeclampedimmediately.

1. Useonlysmooth-edgedclamps.

2. Followthedirectionsofyourdoctorornurse regardingwhentoclamp.

There are different kinds of clamps.

The“bulldogclamp”isasmall,heavywireclampthatopenswhentheendispinched.Thereareothersthatworkinascissorfashionbuthavesmooth-edgedsurfacestoprotectthecatheter.Avoiduseofsurgicalclampsoranyclampsthathavenotbeenapprovedbyyourdoctorornurse.

When should you clamp?

Youshouldclampifthereisanydamagetothecatheterorthecatheterconnector,orifthereisanyseparationofthecatheterandthecatheterconnector:Always have a clamp available for emergencies.

Comments and/or changes as recommended by your nurse or physician.___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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Flushing the PICC

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ThePICCisflushedwithnormalsalinetohelpclearthePICCafterreceivingmedicationsorhavingbloodwithdrawnforlabtests.Yourdoctorornursewilltellyouwhenyouneedtoflushandwithwhatsolution.Ifthecatheterisusedonlyforperiodictreatments,youwillneedtoflushthecatheteronceaweekwithnormalsalinetokeepitopenandfreeofclots.

1.Flushthecatheteraftereveryuse,oratleastweeklywhennotinuse.Usea10mlorlargersyringe.2.Flushthecatheterwithaminimumof10mlof0.9%sodiumchloride,usinga“pulse”or“stop/start”technique.Useofheparinizedsalinetolockeachlumenofthecatheterisoptional.

Note: PeriodsofincreasedphysicalactivitymayrequiremorefrequentflushingofyourPowerPICC SOLO* catheter.Consultyournurseorphysicianforinstructions.

Therearepre-fillednormalsalineflushsyringesavailable,oryoumaybeinstructedonhowtodrawupnormalsalinefromavialintoasyringe.Do not use smaller than a 10 ml syringe for flushing. Do not flush against resistance.

Supplies you will need:

• Alcoholorpovidoneiodinewipe.• A10 mlsyringefilledwithnormalsaline,andprepared

foruse(yournurseordoctorwilltellyouhowmuchnor-malsalinetouse).

The steps in the procedure are:

1. Washyourhandsthoroughly.

2. Collectyoursuppliesinaconvenientplace.

3. Usingfriction,cleanthecapwithanalcoholorpovidoneiodinewipe.Allowthecaptoairdry-besurenottotouchthecapduringthistime.Donotblowontheareaorallowthecleancaptodanglesincethisincreasesthechanceofcontaminationoftheareawithbacteria.

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4. Ifyouareusinganeedlelessadapter/safetyneedlefollowtheinstructionsofyournurseordoctortoproperlyaccesstheinjectioncaporifyouareusinganeedle,removetheneedlecoverandcarefullyinserttheneedleintothecenterofthecatheterinjectioncap.

5. Usinga10mlsyringe,injectthenormalsalineintothecath-eter.Asyouinjectthelast1/2mlofnormalsaline,withdrawtheneedle/syringefromtheinjectioncap.

6. Removetheneedleandsyringefromtheinjectioncap.Discardinaneedlecontainer.

Comments and/or changes as recommended by your nurse or physician.___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Changing the Injection Cap

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Thecatheterinjectioncapistheonlypartofthesystemthatyouwillhavetochange.Theinjectioncapisusedforaccessandthereforeneedstobechangedregularly.Thefrequencywilldependonhowoftenyourcatheterisbeingused.Yourdoctorornursewillinstructyouonhowoftenyouneedtochangeyourcatheterinjectioncap.

Supplies you will need:

1-Sterileinjectioncap1-ChloraPrep*SolutionOne-StepApplicatorNormalsaline1-Syringe

The procedure to change the injection cap:

1. Washyourhandsthoroughly.

2. Openthepackageofthenewinjectioncapandprepareaccordingtoyourinstructions.Besurethecapdoesnottouchtheoutersurfaceofthepackage.

NOTE:Pre-filltheinjectioncapwithnormalsaline.Yourdoctorornursewillteachyouthisadditionalprocedure.

3. Unscrewtheoldinjectioncapanddiscard,holdingthecath-eteradapterbelowthelevelofyourheart.(Thefluidlevelinthecathetermaydroppart-wayintothecatheterifthecon-nectorisheldabovethelevelofyourheart).

4. UsingaChloraPrep*SolutionOne-StepApplicator,cleanaroundthehubwheretheinjectioncapwasconnectedtothecatheter.Becarefulnottotouchtheinsideofthecath-eter.Allowtoairdry.

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5. Pickupthenewprefilledinjectioncaponlybythetop.Attachthenewinjectioncapbyfirmlyscrewingitontothecatheterhub.

6. Repeatsteps3-5forthesecondinjectioncap.

Comments and/or changes as recommended by your nurse or physician.

___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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Don’texpectproblemsbutbepreparediftheyshouldoccur.Thefollowingisalistofpotentialproblemswithspecificinfor-mationabouteach:

PROBLEM Infection

SIGNALS Youmayhaveafeverwithatemperatureover100o F,chills,swelling,oroozingattheinsertionsite.Youmaynoteafoulodor,feelpainorheatfromtheinsertionsite.Generalfatigueordecreaseinactivityinachild,evenwithoutfever,mayindicateaproblem.

WHAT TO DO Callyourdoctorornurse.

HOW TO AVOID IT Followinstructionsatalltimestoavoidcon-taminatingthecatheter.Washhandsbeforebeginninganyproce-dure.Wearamaskifyouhaveacoldoracough.Avoidpersonswhoareill.Doyourproceduresinawellventilated,butdraft-freeplace.

PROBLEM Phlebitis

SIGNALS Youmayhaveredness,tendernessorpain,increasedskintemperature,swelling,ortheveinmayfeelhard.Somepatientsexperienceanincreasedrednessaroundtheinsertionsiteabouttwoweeksafterthecatheterhasbeeninserted.Thiscanbeanormalpartofthehealingprocess.Therednessofnormalheal-ingisNOTaccompaniedbypain,andgoesawayin24-48hours.Yourdoctorornursemaysuggestthatyouapplyawarmcompressseveraltimesdailyuntiltherednessisgone.

WHAT TO DO Callyourdoctorornurse.

HOW TO AVOID IT Avoidstrenuoususeofthearmyourcath-eterisin.Checkyourdressingregularlytomakesurethecatheterremainssecure.Changethedressingeverysevendaysorifitbecomessoiledorloosenedorasinstructedbyyourdoctorornurse.

Be able to Detect Problems and know what to doe

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PROBLEM Breakage or separation of the Catheter, extension leg, or catheter hub

SIGNALS Theremaybeleakingoffluidwhenyouflushthecatheter.Youmaybeabletoseethebreakortheseparationofthecatheterabovethejunction,abrokenextensionleg,orsepa-rationofthecatheterhubfromtheextensionleg.

WHAT TO DO Ifthecatheterbodybreaks,bendthecatheterbackonitselfandtapesecurely.Ifthereisnotenoughcatheterlefttobendbackonitself,carefullypull1-2inchesofthecathe-teroutfromthesite,thenbenditbackonitselfandtapesecure-lytoyourarm.Callyourdoctorornurse.Ifthecatheterbreaksontheextensionleg,bendtheextensionlegonitselfandtapesecurely,callyourdoctorornurseasthismayberepairable.

HOW TO AVOID IT Donotover-twisttheadapterwhenchang-ingtheinjectioncap.Donotusesmallerthana10mlsyringeforflushing.Donotflushagainstresistance.Neverhavescis-sorsorsharpobjectsnearthecatheter.

PROBLEM Disconnected Injection Cap

SIGNALS Theinjectioncapwillbemissing.

WHAT TO DO Ifyoudon’thaveacleaninjectioncap,bendthecatheterbackonitselfandsecurewitharubberbandortape,otherwisecleanthecatheteradapterconnectionandreplacewithacleaninjectioncap.Don’tusethesameinjectioncap.Seechanginginjectioncapinstructions.Removethetapeorrubberband.Callyourdoctorornurse.

HOW TO AVOID IT Secureinjectioncapwhenreplacing.Checktheinjectioncapaftereachuseandperiodicallyeachday,toensureitremainstightandsecure.

PROBLEM Loose Injection Cap

SIGNALS Theinjectioncapwillbelooseandeasilyable toturn.

WHAT TO DO Tighten the injection cap.

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HOW TO AVOID IT Checktheinjectioncapaftereachuseandperiodicallyeachdaytoensureitremainstightandsecure.

PROBLEM Occluded (Blocked) Catheter

SIGNALS Unabletoflushthecatheterusingnormalpressure.

WHAT TO DO DO NOT USE EXTRA PRESSURE.Callyournurseordoctor.Thecatheterwillneedtobeunpluggedbyyournurseordoctor.

HOW TO AVOID IT Flushonaregularschedule,aftereverypro-cedureisdone,orwhenbloodhasbackedupintothecatheter.NOTE:Periodsofphysicalactivitymayrequiremorefrequentflush-ingofyourPICC.Consultyourdoctorornurseforinstructions.

PROBLEM Difficulty Drawing Blood

SIGNALS Youmaybeabletoflushthecathetereasilybutwillnotbeabletowithdrawblood.

WHAT TO DO Callyourdoctorornurse.

HOW TO AVOID IT Thisiscausedbythebody’sattempttowalloffaforeignobjectbycreatingafibrinsleevearoundthecatheter.Itcannotbeavoided.

PROBLEM Air in the Catheter due to Catheter Damage

SIGNALS Youmayseeairinthecatheterorhearairenterthecatheter.ThismayoccurduetobreakageordislodgementoftheconnectionsonthePICC.If sufficient air has entered the catheter you may experience symptoms of shortness of breath, chest pain or lightheadedness. WHAT TO DO IFYOUFEELSHORTNESSOFBREATHORCHESTPAINS,CALL911.THISISAMEDICALEMERGENCY.Liedownonyourleftsideorliedownwithyourfeetwellaboveyourchest.

Ifyouarenotexperiencinganysymptomsorareabletoattendtothecatheter,immediatelybendthecatheterbackonitself,betweenthebreakandtheskininsertionsite,andsecureitwitharubberbandortape.Ifthereisnotenoughcatheterlefttobenditbackonitself,carefullypull1-2inchesofthecatheteroutfromthesite,thenbenditbackonitselfandtapesecurelytoyourarm.Tapetheremainingcathetersecurelytoyourarm.Callassistanceorseeyourdoctortohavethecatheterfixedorremovedassoonaspossible.

HOW TO AVOID IT Donotusesharpobjectsnearthecath-eter.Donotleavecatheterdanglingfrominsertionsite.Makesureallcatheterconnectionsaretightandsecure.

PROBLEM Swelling of Neck & Arm on side of Catheter Insertion (Central Vein Thrombosis)

SIGNALS Youmaynoticeswellingofyourhand,arm,shoul-derorneckonthesideofthecatheterinsertion.

WHAT TO DO Callyourdoctor.Hewillneedtoseeyouassoonaspossible.

HOW TO AVOID IT Thishappenstoacertainnumberofpeo-ple.Thereasonisunknown.Callyourdoctorornurse.

PROBLEM Swelling at Exit Site SIGNALS Youwillnoticealumpincreasinginsizeovertheinsertionsiteandoccurringshortlyaftertheinsertionprocedure.

WHAT TO DO Applygentlepressureoverthedressingforafewminutes.Puticeinaplasticbagandapplyoverthedress-ing.Besurenottogetthedressingwet.Callyourdoctorornurseiftheswellingcontinues.

HOW TO AVOID IT Followinstructionsofyourphysicianornurseregardinganyrestrictionsofvigorousactivitiesimmedi-atelyafterinsertion.

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Questions Other PatientsHave Asked

How will I know that everything is okay?

Whenyoulookatthecatheterandinsertionsite,andyoudon’tseeanythingunusual,beconfidentthattherearenoproblems.Somepatientsexperienceanincreasedrednessaroundtheinsertionsiteabouttwoweeksafterthecatheterhasbeeninserted.Thiscanbeanormalpartofthehealingprocess.TherednessofnormalhealingisNOTaccompaniedbypain,andgoesawayin24-48hours.Yourdoctorornursemaysuggestthatyouapplyawarmcompressseveraltimesdailyuntiltherednessisgone.Thereshouldnotbeanydrainagearoundthecatheteratthistime.Youwillalsoknowthateverythingisokayifyoucanflushyourcatheterfreely.

Duringthetimeyouhavethecatheter,yourdoctorornursemayhaveyoutakeyourtemperatureeverydayandmayrequestthatyoumakeotherperiodicobservations.Thiswillbeanotherwayofmakingsureeverythingisokay.

How will I know if something is wrong?

Ifyouexperienceproblemswiththeflushingprocedure,youmayhaveaclottingproblemwhichrequiresimmediateatten-tionbyyourdoctorornurse.

Alowgradetemperatureandafeelingofgeneralfatigue/weaknessthatlastsformorethan24hoursmaymeanthebeginningofaninfection.Ifachildbecomeslessactivefornoapparentreasonforlongerthanusual,aninfectionmaybestartingeventhoughthereisnoincreaseintemperature.

Ifyouhaveafeverwithatemperaturehigherthan100°F,callyourdoctorornurseimmediately.Contactyourdoctorornurseassoonasyoususpectthatsomethingiswrong.

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Are there any special instructions when caring for a child with a PICC?

Note:Periodsofincreasedphysicalactivitymayrequiremorefrequentflushingofyourchild’sPowerPICC SOLO* catheter.Consultyournurseorphysicianforinstructions.Theremayneedtobesomeactivitylimitations,especiallyjustafterthePICCisinserted.Substitutingquieteractivityisrecommendedinsteadofimposingactivityrestrictions.

Thechildshouldwearsometypeofclosefittingclothingcoveringthearmtohelpkeepcuriousfingersfromhan-dlingthecatheter.Notonlyisthereadangerofpullingoutthecatheter,butalsoofcontaminationoftheinsertionsitefromexcessivehandling.Thistypeofclothingwillalsopreventthechildfromputtingthecatheterinhisorhermouthorfromchewingonthecatheter.Itwillbeneces-sarytolookatthecatheterundertheclothingatintervalsduringtheday.

Ifthechildisleftinthecareofapersonwhoisnottrainedincathetercare,areviewofemergencyproceduresshouldbedone.Thisshouldbescheduledpriortothetimethepersonwillcareforthechild.Alsomakesurethatemer-gencyinformationandemergencyphonenumbersareavailableforthecaregiver.

Can I bathe?

Youshouldaskyourdoctorthisquestion.Theanswerwilldependonyourgeneralhealthandgeneralriskofinfec-tion.Itwillalsodependonhowlongyouhavehadthecatheterinplace.Thedoctormayallowyoutobatheaslongasyoudonotgetthecatheterdressingwetordamp.

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Does the insertion site always need a bandage?

Theinsertionsiteshouldalwayshavesometypeofdress-ingorbandageonit.Thetypeyouusewilldependontherecommendationbyyourdoctorandwhatworksbestforyou.Thedressingshouldbechangedeverysevendaysandasneededifthedressingisloose,soiledordamp,orasinstructedbyyourdoctorornurse.

What do I do if I get a cold or cough?

Ifyouhaveacoldorcough,yourdoctorornursemayinstructyoutowearamaskwhenyouarecaringforthecatheter,especiallyduringthecapchangeanddressingchangeprocedures.

If I forget to flush on time, what should I do?

Youshouldflushthecatheterassoonasyouremember.Neverforcefluidintothecatheter,especiallyifithasbeenawhilesinceyouflushed.Ifyouexperiencedifficultyflush-ing,contactyourdoctorornurseimmediately.

What happens if I can’t flush the catheter?

Ifyouhavedifficultyflushingthecatheter,checkyourcath-etertobesurethattherearenokinksorotherobstructionsinthecatheter.DO NOTtrytoflushagainstresistance!

Ifthecatheterisnotkinkedorobstructedandyoustillcan-notflushusingthesmallamountofpressurethatyouhavebeenapplying,contactyourdoctorornurseimmediately.Youmayhaveaclotinthecatheter.Neverattempttodoanythingwiththecatheterthatyouwerenottaughttodo.Youmaydislodgeaclotintothebloodstreamoryoumaydamagethecatheter.

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What happens to the PICC if it is damaged?

Afteryouhavetakentheprecautionofbendingthecath-eteronitselfandsecuringitwitharubberbandortape,youwillneedtohaveitrepairedorreplaced.Therepairorreplacementmustbedoneusingspecialequipment.Ifthereisnotenoughcatheterlefttobenditbackonitself,carefullypullout1-2inchesofthecatheterfromtheinser-tionsite.Tapetheremainingcathetersecurelytoyourarm.

If I break the needle in the injection cap, what should I do?

Removetheinjectioncapandbrokenneedle.Applyanewinjectioncapaspreviouslyinstructedandcompletetheflushingprocedure.Ifunabletoremovethebrokenneedle,carefullypullout1-2inchesofthecatheterfromtheinser-tionsite,bendthecatheterbackonitselfandtapedownsecurely.Callyourdoctorornurse.

If I run out of supplies, what should I do?

Callthehospital,company,orpharmacythatissupplyingyouwithwhatyouneed.Ifyourunoutofsuppliesandcan’treachyoursupplier,callyournurse,doctororlocalpharmacistforassistance.Youshouldalwayshaveextrasuppliesonhandsothatyouwon’trunout.

If blood backs up into the catheter, is something wrong?

Bloodinthecapandcatheterwon’thurtyoubutitmayenhancethegrowthofbacteriaandincreasetheriskofclottingorinfections.Bloodusuallybacksupintothecath-eteronlywhenthereisincreasedinternalpressurethatiscreatedbysomeformofphysicalactivityorbendingover,orifaclotisholdingthevalveopen.Ifbloodisnoticed,youshouldflushthecatheterassoonaspossible.

21

What happens if the catheter won’t come out when I don’t need it anymore?

Thecatheterisremovedbypullingitout.Thecath-eterismadeofamaterialdesignedtoeasilyslipinandoutofskinandbloodvessels.Thepersonremovingthecatheterhasbeenspeciallytrainedtohandlethepro-cedureandtherareproblemsthatmayoccur.

What happens if the catheter breaks?

Thepartofthesystemthatismostlikelytobreakistheendofthecatheterthatholdstheinjectioncap.Ifthisshouldoccur,immediatelybendthecatheteronitselfbetweenthebreakandtheskininsertionsite,securingitwitharubberbandortape.Ifthereisnotenoughcatheterlefttobenditbackonitself,carefullypullout1-2inchesofthecatheterfromthesite,thenbenditbackonitselfandtapesecurelytoyourarm.Tapetheremainingcathetersecurelytoyourarm. Call your doctor or nurse.

What happens if the catheter gets pulled out?

Sincethecatheterisanchoredtoyourskin,itishighlyunlikelythatitwillcomeoutunlessitispulledon.Thecathetermaystretchabitafterithasbeenusedawhile,anditmayseemlikeithasslippedout.Ifyoususpectthatthecatheterisslippingout,callyournurseordoctor

If I have a treatment, do I need to flush the catheter?

Thefinalstepinanytreatmentdonethroughthecatheterisaflushofsometype.Ifthecatheterhasbeenflushedfollowingtreatment,usethattimeasthelastflushandscheduleyournextflushattherecommendedinterval.Besuretocheckwithyourdoctorornurse,sincetheflushingprocedurevariesdependingonwhatthecatheterisbeingusedforandyourlevelofactivity.

22

Can I engage in sexual activity when I have the catheter?

Thereisnoprohibitionagainstsexualactivitybecauseofthecatheter.Somesafetyprecautionstakenbeforeyoubeginanyactivityshouldbeobserved.Thedressingattheinsertionsiteshouldbesecureandthecathetershouldbecompletelycoveredbythedressingandsecuredwithtapeatthehubsoitisnothangingfree.Ifbloodisnoticedinthecatheter,flushitwith10mlofnormalsaline.Donothesitatetodiscussthiswithyourdoctorornurse.

What should I do if I become allergic to tape?

Thereareotherchoicesofhypoallergenictapesthatcanbeused.Itisimportanttobeawareofanyskinproblemsneartheinsertionsitebecausethedangerofinfectionincreasesifthereisskinirritation.

Should I wear a medical alert type bracelet or have some other information available regarding my cath-eter?

Itwouldbeaverygoodideatowearsomethingtoalertothersthatyouhaveaperipherallyinsertedcentralvenouscatheter.Ifyouwereinanaccidentorbecameillandcouldn’tgivethistypeofinformationyourself,thebraceletcouldbelifesavingbyinformingemergencypersonnelthatyouhaveacatheter.TherearecommercialcompaniesthathavemedicalalertbraceletsoryoumaywanttoaskforahospitaltypeplasticwaterproofI.D.bandasatempo-rarymeasure.AnotheroptionisthecatheterMaintenance/I.D.cardgiventoyoubyyournurseorphysician.Placethecardinyourwalletandcarryitwithyouatalltimes.

Should someone else learn the procedures?

MostpeoplecannotchangeaPICCdressingbythem-selves.Havinganotherpersonavailablewhohasbeentrainedinallofthenecessaryproceduresisimportant.Themostimportantthingisthatsomeoneelseknowshowtodoemergencyprocedures.

23

I’ve heard that some chemicals can hurt the catheter. Is this true?

Somechemicalscandamagethecatheter.Itisimportantnottouseanythingnearthecatheterunlessyoucheckwithyourdoctorornurse.Acetone,suchasthatfoundinnailpolishremoverorsometaperemovers,isespeciallyharmfulandshouldnotbeused.

How long can the catheter stay in place?

Yourdoctoristhebestsourceforthisanswer.Thecathe-terisdesignedtostayinplaceforlongperiodsoftime,buteachpatientsituationisunique.Theanswerdependsonwhatthecatheterisusedfor,yourgeneralhealth,andthecareandattentionpaidtotheprocedures.Thebettercareyoutakeofyourcatheter,thelongeryoumaybewithoutcomplications.

Comments and/or changes as recommended by your nurse or physician._____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________

“YOU CAN MAKE A DIFFERENCE!”

24

AnswerthefollowingquestionsbycirclingTfortrueorF forfalse.Theanswersareonthenextpage. 1. Ifthereisabreakinthecatheter,thefirstthingthatI

shoulddoiscallthedoctor.T F

2. Ifthecapbecomesloose,itshouldbetightenedimme-diately.

T F

3. Ifthecapfallsoff,replaceitimmediately.

T F

4. “SiteCare”mustbedonebetween9and10a.m.

T F

5. Itisokaytousemoreforceduringtheflushproceduretogettheflowgoing.

T F

6. Icanjogordootheractivitiesaslongasitisokaywithmydoctorornurse.

T F

7. Topreventcontamination,Ishouldkeepthecatheterundermyclothingandnotdisturbitbetweenflushes.

T F

8. Duringthedressingchange,ifInoticethatthecatheterhascomeoutalittlebit,Ishouldpushitbackin.

T F

Quiz7

25

1. False.Thefirstthingtodoistobendthecatheterbackonitselfandsecurewitharubberbandortape,thencallthedoctorornurse.

2. True.

3. False.Thecapneedstobereplacedbutwithasterilecap.Ifthesamecapisreappliedthereisanincreasedriskofinfection.Followthefullprocedureforcapchange.

4. False.Youcando“sitecare”at3a.m.ifyouwish,aslongasyoudoitonaregularbasisandarealertenoughtodotheprocedurecarefully.

5. False.Youmaydislodgeabloodclotorrupturethecatheterwhichisdangerous.Ifyouhavedifficultyflushing,stoptheprocedureandcallyourdoctorornurse.

6. True.Thecathetershouldnotinterferewithyournor-malactivityaslongasyougetpermissionfortheactiv-ityfromyourdoctorornurse.

7. False.Youshouldperiodicallylookatthecatheter,especiallyiflongperiodsoftimeelapsebetweenflush-es.Thisisespeciallytruefortheperiodoftimeimme-diatelyfollowingtheinsertionofthecatheter.

8. False.Youshouldcallyourdoctorornurse.Nevertrytore-insertthecatheter.Thismayleadtoaninfection.

Answers7

26

Comments and/or changes as recommended by your nurse or physician.

______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ___________________________________________________________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ______________________________________________________

27

PatientName: _______________________________Date: ________

BaseLineRight/LeftUpperArmCircumferencewas____________cm.

CatheterFrenchSize: _________ ProductCode: ________________

NameofCatheter: ____________ CatheterLengthcm: ___________

LotNo.: ____________________ PICCwasinsertedviatheRight/Left

Basilic/CephalicVein.BloodReturnwasObtained/NotObtained. ____

______cm.ofinsertablecatheterlengthexposedfrominsertionsite.

Hospital: ___________________________ Phone: _____________

Doctor: ____________________________ Phone: _____________

Nurse: ____________________________ Phone: _____________

Supplier: __________________________ Phone: _____________

ListofSuppliesNeeded:

DressingSupplies: FlushingSupplies:

_________________________ ___________________________

_________________________ ___________________________

_________________________ ___________________________

_________________________ ___________________________

_________________________ ___________________________

_________________________ ___________________________

CatheterCareSchedule: ___________________________________

SUN MON TUE WED THU FRI SAT

SiteCare:

Flushing:

CapChange:

SpecialInstructions: _______________________________________

________________________________________________________

Catheter Information and Supply List8

8Acknowledgement Card

(Placeinpatientmedicalrecord)

I,_______________________________havereceivedthebooklet-- How to Care for your PowerPICC SOLO* Catheter --from______________________________.

(printnameofpersongivingbooklettopatientorcare-giver)

________________________ ________(signed) (date)

________________________ ________(signed) (date)

9

ChloraPrep* Solution One-Step Applicator Active Ingredients

•Chlorhexidinegluconate2%w/v...antiseptic •Isopropylalcohol70%v/v...antiseptic

Inactive Ingredients

•USPpurifiedwater

ForfurtherinformationorquestionsregardingChloraPrep*One-StepApplicatorcall:1-800-523-0502(8a.m.-5p.m.CST)

Anissuedorrevisiondatefortheseinstructionsisincludedforuser’sinformation.Intheeventtwoyearshaveelapsedbetweenthisdateandproductuse,theusershouldcontactBard Access Systems, Inc. toseeifadditionalproductinformationisavailable.

RevisedDate:July2007.

07145840707R

©2007CopyrightC. R. Bard, Inc. Allrightsreserved.*Bard,PowerPICC,PowerPICCSOLO,Power.Saline.One.,andthecolorpurplearetrademarksand/orregisteredtrademarksofC.R.Bard,Inc.oranaffiliate.*ChloraPrepisaregisteredtrademarkofEnturia,Inc.oranaffiliate.

Bard Access Systems, Inc.

SaltLakeCity,Utah84116TollFreeOrderDepartment: 1-800-545-0890ClinicalInformationHotline: 1-800-443-3385www.bardaccess.comwww.powerpiccsolo.com