I’ve already learned a couple of things this first week in my job! Mostly related to changing the dressings on PICC lines. Since I was reminded several times that “Hey, it’s just you out there in the field – no stopping Jane RN who’s passing in the hallway to ask if she can grab you a Biopatch” I thought I’d share the two main tips I learned. (Hang in there – fun story at the bottom of the post!)
First is in regards to the statlock. I was in the habit of taking the entire tegaderm dressing off, then fiddling with getting the statlock off and unstuck from the patient. This sometimes jostled the PICC, which is obviously not a good thing.
I learned to take off the tegaderm until it was clear of the statlock, (but still covering the catheter at the insertion site) THEN take the statlock off. Once that’s off, tape down the ports and finish removing the tegaderm. This keeps the PICC nicely in place under the tegaderm while you’re messing with the Statlock.
The second thing I learned – and I am completely embarrassed to admit that I never really gave it any thought, thereby ensuring that the next person to change the PICC dressing I’d done probably cursed me – is to always put the slit of the Biopatch around the PICC line itself. That way, when you take off the tegaderm, the Biopatch just comes right off with it. I was in the habit of putting the Biopatch on then rotating it for whatever reason – to make sure it stayed on? Like it was really going to go anywhere under the tegaderm? Here‘s a great picture of what it should look like. I *KNOW* I am not the only person who does it wrong, because I have changed many PICC dressings wherein the tegaderm was stuck to the Biopatch and it took forever to get it all apart while trying to preserve the PICC line.
I was beyond (BEYOND) happy to find out that hospice nurses at this organization do not start peripheral IV’s. We may do venipuncture for labs, but no starting IV’s. I am very bad at starting IV’s. I will even go so far as to admit that I have not successfully started an IV in over 5 years. To qualify, though – I was only working one day per week in all that time, and I worked in CCU. CCU patients have central lines and PICCs. And I always seemed to be working with nurses who were masters at starting hard IV’s so all I had to do was ask, and someone would come do it for me.
My IV-starting mojo was damaged early on, and I will tell you why. When I was working in my very first job as a nurse, my grandfather had to come to the hospital I was working at for carotid surgery. I went to visit him on the med/surg floor during a break from my shift and his nurse noticed that his IV had infiltrated. He needed a new one. She tried 2 or 3 times, but couldn’t restart it. Another nurse was sent in – she also tried several times without success. With the nurse’s permission (and my grandfather’s), I then tried to start the IV.
I found a suitable vein and prepped the skin. Right before I stuck the the needle in, I offered up a silent prayer: “Please, if the gods are listening – I really want to get this IV in. If I never start another IV again, please PLEASE let me be able to start this one.”
I got it in on the first try…. and the gods were listening. Although I have successfully started many IV’s since that day, I have never been very good at it overall. Ah well. I was good at it when it really counted :-)