经外周静脉中心静脉置管（PICC）

a guide for patients and their carers care of your peripherally inserted central catheter (PICC) contents This booklet contains the following information about your peripherally inserted central catheter: what is a PICC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 why do I need have one? . . . . . . . . . . . . . . . . . . . . . . . . . 1 how is it put in? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 what are the risks of PICC insertion . . . . . . . . . . . . . . . . . 2 what do I need to look out for after insertion of my PICC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 who will care for it? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 how will I know if something is wrong? . . . . . . . . . . . . . 4 frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . 5 information for District Nurses . . . . . . . . . . . . . . . . . . . . . . . . 6 (Groshong Valve) Catheter: thin blue flexible tube lies under the skin Entrance to vein Line secured to skin Bung Tip 1 A PICC is a peripherally inserted central catheter. It is a thin flexible tube that is inserted into a vein, usually in the bend of your arm. The PICC is then threaded so that the tip lies in one of the large veins in the chest. It can remain in position for up to six months. A specially trained nurse or doctor will insert your PICC. Not all patients are suitable for a PICC, so a doctor or nurse will assess you before one is inserted. The illustration on the left shows the PICC line, and where it enters the vein at the inside of the elbow. what is a PICC? A PICC is ideal for people who: ■ have small veins which are difficult to find or access ■ are very anxious about needles ■ need treatment such as chemotherapy A PICC can be used to give you chemotherapy, fluids, antibiotics or other drugs directly into the bloodstream. It can also be used for taking blood samples. A PICC is ideal for patients who have small veins which are difficult to find or access, who are very anxious about needles or who need continuous treatment such as chemotherapy. Occasionally it may be difficult to thread a PICC line. why do I need to have one? 22 how is it put in? The doctor or nurse will apply local anaesthetic cream to the area where the line will be put in at least an hour before insertion, or they may inject some local anaesthetic just before inserting the PICC line. This should ensure that the procedure is less painful. You will need to lie down while your PICC is inserted. The procedure should take approximately 40 minutes to an hour. After your PICC is inserted, you will have a chest x-ray to confirm that your line is in the correct position. The nurse will also ask you if you can bend your arm without discomfort. The PICC will be held in place with steri-strips or sutures and covered with a clear, waterproof dressing. what are the risks of PICC insertion As with most procedures there is a small risk of complications which may include: ■ infection: as with all surgical procedures there is a risk of infection occurring ■ accidental puncture of the artery which may cause bleeding ■ the catheter tip in the vein is not in the correct position. Please ensure you have received answers to all your questions before consenting to the procedure. If you have any problems or queries, please contact one of the procedure team nurses on 0161-446 3916. 3 what do I need to look out for after insertion of my PICC? Sometimes you may have some tenderness, swelling or inflammation of the upper arm where your PICC was inserted. This reaction is most common in the first week following insertion. To minimize these reactions, you can do light arm exercises and apply warm compresses for 20 minutes, 4 times a day. Also, if you have any tenderness or pain in your arm, taking a simple pain killer such as paracetamol may help. If the pain persists, ring 0161 446 3658 for advice. who will care for it? While you are in hospital, the nursing staff will look after your PICC. This involves: ■ cleaning the exit site and applying a new dressing weekly ■ flushing the line weekly to prevent blocking when it is not in use When you leave hospital, we will contact the district nurse in your area to call at your home to flush your line. We will also give the district nurse a letter outlining how to care for your PICC and all the equipment needed for the first flush. If you have any problems at home, please ring the Christie hospital using the numbers at the end of this booklet. If you are worried about any aspect of your PICC or appearance, please do not hesitate to contact your ward or the chemotherapy suite for further advice. Please note: If you experience a cold and shivery attack during or after flushing your line, contact the hospital immediately as this could be the beginning of an infection. Phone the hotline on 0161-446-3658. Flushing the line: This should always be a sterile procedure. So do not hesitate to remind anyone who handles your PICC to wash their hands and to wear sterile gloves in order to protect you from infection. If you have an infusor connected continuously to your PICC, it will require flushing after it empties. For further information, see ‘The Baxter Infusor - A Patient’s Guide’. how will I know if something is wrong? Sometimes there are complications. If you suspect something is wrong, or if you have any of the following, contact the hospital straightaway: ■ if you have a temperature above 37.5C, fever, chills or feel generally unwell. This could be the beginning of an infection ■ oozing from around the line ■ cracks or leaks in the line ■ pain, redness or swelling around the site, in your neck or arm ■ if your PICC becomes dislodged 4 frequently asked questions Can I eat and drink before having my PICC inserted? Yes, you can eat and drink normally before having your PICC inserted. Can I have a bath / shower and swim? Any advice we give about a particular activity or sport takes into account the risk of infection or damage to your PICC. As a general rule, we encourage people with PICCs to take a shower. This is preferable to submerging your line and PICC in bathwater because of the risk of infection. Swimming is discouraged for the same reason. Can I lead a normal social life? Having a PICC in place should not interfere with your social life. However, your chemotherapy drugs may temporarily restrict certain social activities either immediately after treatment or if your ‘blood counts’ are low. Your nurse or doctor will give you more specific information. Can I play sports? Sports such as tennis and golf or vigorous gym exercises are discouraged. There is a risk that your PICC could become dislodged because of excessive upper body movement. However, there are many other pursuits which are acceptable. If in doubt ask your nurse or doctor. Can I go on holiday? Please talk to your doctor before planning a trip abroad. It is possible to holiday at home and abroad with a PICC in place. However, you need to consider the type of treatment you are having, the duration and destination of your holiday, and whether you have someone to help care for your PICC. If you do travel by air, carry all medication in your hand luggage. Will my PICC affect my sex life? Having a PICC in place should not interfere with your sex life. To minimize the risk of damage to your PICC, ensure it is secure before making love. However, sometimes while you are feeling unwell or having cancer treatment you may lose interest in sex. Adequate contraception is essential during cancer treatment to avoid pregnancy because of the risk of damage to the baby. Further information is available in the Christie booklet ‘Sexuality, cancer and you’ 5 6 information for district nurses PICC maintenance procedure for district nurses Your patient had a Peripherally Inserted Central Catheter (PICC) placed on The tip of the lumen is positioned in the superior vena cava and requires a strict aseptic technique whenever accessing or dressing the device. The end of the PICC line exits the body at the anti-cubital fossa. PICCs differ from Hickman lines in that they have a pressure sensitive two-way valve at the internal end of the PICC. This valve opens outwards to allow fluid to be injected into the catheter and inwards to allow blood to be withdrawn. When not in use the valve remains closed, thus preventing blood from flowing back into the catheter and air entering the venous circulation. Clamps or switches are not required. Maintenance of this PICC will require a weekly flush with 10mls of N/Saline and a dressing change at least weekly or as required. Hepsal is not required for flushing this device. The procedure for flushing and dressing the PICC is outlined on page 8. If you have any queries or concerns about any aspect of care and maintenance of PICCs or if you would like to observe this procedure at the Christie hospital (Monday to Friday from 0900-1300) please contact the Chemotherapy Suite on 0161-446 3447. Nursing care following PICC placement The patient should be monitored for the following potential complications: 7 ■ Bleeding from insertion site If this occurs, apply a sterile gauze pressure dressing to the site for 24 hours. Observe the site, then change to a transparent dressing such as IV 3000 or tegaderm depending on availability. ■ Bruising at insertion site Related to vein trauma at insertion. Monitor for changes. ■ Inflammation, oedema and/or tenderness above site This may be related to trauma and possible chemical or dressing reactions and may involve the anti-cubital fossa region of the arm. Change dressing to another occlusive type and monitor. If problems persist, please contact the Chemotherapy Suite (0161-446 3447) for advice. ■ Mechanical phlebitis This is inflammation of the vein caused by the body’s response to the catheter and may involve the inner proximal region of the arm. This may occur more commonly during the first 7 days post insertion, but may be a delayed response. Please contact the Chemotherapy Suite (0161-446 3447) for advice. This is not an infection process. We advise patients to perform light arm exercises and to apply warm compresses intermittently (for example, 20 minutes at a time for 48 hours) post insertion. This will dilate the vein and encourage blood flow, and may need to be continued until the reaction settles. We also ask patients to monitor their temperature during this period, and to contact the Chemotherapy Hotline on 0161-446 3658 if abnormalities are detected. 8 Equipment required: Sterile dressing pack containing gloves Chlorhexidine 0.5% in spirit 2 large IV 3000 dressings (10cm x 14cm) or transparent occlusive dressing 2 10mls syringes (do not use anything smaller than a 10ml syringe when using a PICC) 20ml syringe Green needle x 2 10mls of saline x 2 2 large alcowipes Sterile bung Steri-strips Procedure ■ Wash and dry hands thoroughly. Open sterile dressing pack and all other equipment onto a sterile field. Open saline container and place at edge of your sterile field and pour chlorhexidine into gallipot ■ Loosen and remove dressing gently, starting at the bung and carefully pulling up towards the exit site ensuring the PICC remains secured by steri-strips or sutures. Inspect site for signs of tenderness, inflammation and/or swelling. ■ Wash hands and put on sterile gloves. Draw up saline with a needle and syringe maintaining a sterile technique. ■ Wrap end of catheter in an alcowipe, then pick up and clean ensuring your gloves do not come into contact with the catheter and remain sterile. Then place the sterile dressing towel underneath the catheter before resting the device on the patient’s arm. 9 ■ Discard the old bung and clean the tip of the catheter with a clean alcowipe. Next attach the empty 10ml syringe to the tip and pull back on the plunger very slowly to 2-3mls. Hold this position for up to 1 minute to allow the valve to open and for the blood to travel down the fine lumen. Withdraw 5mls of blood and discard. (If you are unable to get a blood return, repeat this technique using a 20ml syringe or alternatively give the device a 2-3ml flush with saline). Remember to be very patient! ■ Without delay (to prevent blocking) attach the 10ml syringe of saline, then flush catheter with 5mls of saline using a brisk push/pause technique. Clean the tip with a clean alcowipe and attach a clean bung. ■ Attach green needle to the 10ml syringe and again flush the catheter with the remaining 5mls of saline, this time, through the rubber bung inserting the needle only halfway in. Whilst flushing the last ml of saline, withdraw the needle maintaining a positive pressure (if a fine spray of saline into the air is observed, your technique is perfect as a positive pressure has been maintained preventing any backflow of blood). ■ Clean insertion site using solution and gauze and allow to dry. Reapply steri-strips prn and affix occlusive transparent dressing/s. This dressing should entirely cover the device from the entry site to the bung, to provide a waterproof barrier and must be comfortable to the patient. If you experience any difficulties with the above, please contact the Procedure Team on 0161-446 3916 for advice. Note: Equipment will be supplied for the first procedure only. Please ensure further dressings etc are supplied by the patient’s GP or local hospital. Christie Hospital Patient Information Service - February 2003 www.christie.nhs.uk If anything unusual occurs, or you are at all worried, contact the chemotherapy hotline at the Christie Hospital chemotherapy hotline Your consultant is: The line is open 24 hours a day for urgent enquires. 0161-446-3658 CHR/070/17.01.03