PREVENTING INTRAVASCULAR DEVICE (IVD)-RELATED

BLOODSTREAM INFECTIONS (BSIs)

PROCEDURE COMPLIANCE CHECKLIST
PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS (PICC)

The Procedure Compliance Checklist for Peripherally Inserted Central Venous Catheters (PICC) contains
indicators that should be utilised to measure compliance of existing policies and procedures with the
Recommended Practices for Peripherally Inserted Central Venous Catheters (PICC) (PICC Recommended
Practices). The Recommended Practices contain current guidelines for infections related to intravascular devices.

It is important that the review involve all staff responsible for the insertion, management and surveillance of
intravascular devices within the facility, for example –
• Infection Control
• Infectious Diseases/Microbiology
• Radiology
• Intensive Care, High Dependency and Critical Care Units
• Anaesthetic Unit
• Haematology/Oncology Unit
• Renal/Nephrology Unit
• Specialist Clinical Nurses e.g. TPN, IV Team
• Emergency Department
• Medical and Surgical Units
• Clinical Product Coordinator/Supply Representative
• Quality and Safety Representative
• Patient Safety Officer
• Staff Development Educator(s).

Whilst the recommended practices are intended to prevent healthcare associated PICC-related bloodstream
infections (BSI), some of the measures outlined in the checklist relate to prevention of other complications.
CHRISP will continue to update the I-CARE eToolkit as necessary to incorporate additional information and to
reflect increased understanding of intravascular device-related BSI prevention strategies including technology.

CHRISP Peripherally Inserted Central Venous Catheter (PICC) Procedure Compliance Checklist Version 2 - January 2009
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Measure Compliant
Yes No N/A
Education
A system of credentialling and maintenance of competency is in place within the facility for PICC insertion
Education is provided to staff on the insertion and maintenance of PICC
Operator
Only skilled practitioners insert PICC or training staff supervised by an experienced operator
General
A dedicated PICC insertion trolley/cart is available in all areas that insert PICCs
Details of PICC insertion are included in the patient’s medical record
An adhesive label indicating insertion details is available for placement on the PICC dressing
A prompt for early removal of PICC is included in daily ward rounds
Clinical Nurse Specialists are appointed to manage high-risk populations and/or high-risk IVDs
Surveillance
A process for surveillance of healthcare associated (HCA) IVD-related BSIs exists within the facility
Standardised surveillance methodology including definitions are utilised by Infection Control staff
A process for collecting denominator data has been established (number of PICC days in high-risk unit)
Rates of HCA IVD-related BSIs are reported monthly to high-risk units
All episodes of HCA IVD-related Staphylococcus aureus BSI are investigated by Infection Control staff using the Investigation Checklist
There is a process for advising Infection Control staff when a new IVD is introduced into the facility including needleless access devices
Location of Performing PICC Insertion
Appropriate area(s) are designated for PICC insertion (i.e. area where asepsis can be maintained) e.g. Dedicated Procedure Room, Radiology
Suite)
Ultrasound guided access is available for PICC access
PICC Selection
A process exists to ensure appropriate catheters are purchased by the facility
Antimicrobial catheters are only used according to the Recommended Practice
A process exists to ensure the most appropriate catheter is selected based on patient factors, type and duration of therapy
• The selection of the IVD-type should also consider care/patient preference if the catheter is to be used in the home environment

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Measure Compliant
Yes No N/A
Prophylactic Antibiotics
Prophylactic antibiotics including antimicrobial lock prophylaxis are not used for routine PICC insertion
Patient Preparation
Formal patient assessment is undertaken by the operator prior to catheterisation in relation to type of device and site selection
Beds or procedure tables are able to be adjusted to place the patient in the supine position and support the selected arm at a right angle to the
body
The correct procedure for measuring the patient to assess the required PICC length is available
Local anaesthetic is administered prior to PICC insertion
The patient is monitored for insertion-related complications e.g. bleeding, nerve damage, catheter malposition, cardiac arrhythmias
Hand Hygiene
A procedure is available stating indications for performing hand hygiene including glove use
Appropriate hand hygiene products are available
Education is provided to staff in relation to hand hygiene
PICC Insertion (including guide-wire exchanges)
The sterile field is set up immediately prior to procedure
Maximal barrier precautions are worn by the operator and any person who enters the sterile field to assist in the procedure
Appropriate skin preparation is undertaken prior to PICC insertion:
1. Hair removal method used is clippers
2. Skin at the insertion site is physically cleaned if necessary
3. Skin lipids are not removed using alcohol, ether or acetone
4. Alcoholic chlorhexidine is available for skin preparation
5. Other antiseptics are available for patients in whom alcoholic chlorhexidine is contraindicated
6. 70% alcohol solution (including alcohol-impregnated wipes) is not used for skin preparation
7. The method of antiseptic application is stated including drying time
Maximal sterile barrier procedure including full body drape are used by the operator (consider developing a standardised insertion pack)
Insertion technique incorporates maintenance of asepsis including not palpating the insertion site after the application of antiseptic
Antimicrobial ointments or creams are not used under the dressing on the insertion site (excluding haemodialysis catheters)
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Measure Compliant
Yes No N/A
PICC Insertion (including guide-wire exchanges)
A standardised method of catheter fixation that minimises infection and maintains stability is established
An appropriate dressing is applied to the PICC site
A modified chest X-ray is performed post-PICC insertion
The patient is monitored post-PICC insertion for complications
PICC Dressings
Aseptic technique including sterile dressing pack with drape and sterile gloves is used for dressing changes
Appropriate skin preparation including use of antiseptics is undertaken for PICC dressing changes (refer PICC Insertion measures)
Recommendations for the type of dressing and indications for changing dressings are available (i.e. transparent, semi-permeable and gauze)
Each catheter (if applicable) is dressed as a separate procedure
PICC Monitoring
Recommendations for the visual inspection of insertion sites include signs of infection i.e. erythema, drainage, tenderness, pain, redness, swelling
Intravenous Infusions and Medications
Intravenous fluids and medications are stored according to manufacturer’s recommendations
Facilities to admix intravenous fluids using sterile technique are available
Procedure includes contraindications to use of intravenous fluids e.g. expiration date passed
Appropriate gauge needles are used for injecting additives into infusion bags, intravenous access ports, and/or burettes
All intravenous fluids are replaced at the recommended intervals
The infusion and administration set is replaced when the PICC is resited regardless of when the infusion was initially commenced
Administration Sets
All components of the administration system available in the facility are compatible including needless intravascular devices
Administration sets are changed at the recommended intervals
The procedure for changing administration sets includes the appropriate location for connecting and priming the system whilst maintaining asepsis

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Measure Compliant
Yes No N/A
Administration Sets
The procedure for connection and disconnection of administration sets, includes liberally swabbing all connectors with sterile, single-use 70%
alcohol-impregnated swabs or alcoholic chlorhexidine
The procedure includes management of accidental disconnection of both needleless and conventional systems
Adhesive tape is not used to secure the junction between the catheter hub and access port/infusion line
In-line filters are not recommended to prevent infection
Intravenous Access/Ports
A procedure for blood collection via a PICC is available and includes a recommendation to batch laboratory specimen draws
All intravenous access ports are cleaned with a sterile, single-use alcohol-impregnated swab prior to being accessed
The procedure includes guidelines for changing of intravenous access ports at recommended intervals and if the integrity of the port is
compromised
Flushing and Locking of PICCs
Recommended volume for flushing and locking of PICC is equal to at least twice the volume of the catheter plus add-on devices (usually minimum
2-3mL)
Minimum 10mL syringe is recommended for flushing and locking of PICC
Procedure for flushing in a pulsatile motion stated
Procedure for positive pressure technique stated (if positive displacement mechanical valve not used)
Indications for flushing and locking of PICC included in procedure
Sterile 0.9% sodium chloride used for flushing and locking of PICC
The flush solution and flushing intervals are documented on the medication chart
Catheter Duration and Replacement including Guide-wire Exchanges
PICC are only replaced on clinical indications
PICC are not routinely replaced using a guide-wire exchange to prevent infection
PICC are not replaced using a guide-wire exchange in the presence of a BSI
PICC inserted in other hospitals are reviewed on admission for complications

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Measure Compliant
Yes No N/A
Blood Culture Collection for Diagnosis of a BSI
Staff have access to the Queensland Health Pathology and Scientific Services (QHPSS) Pathology Handbook
A procedure for blood culture collection including collection through the catheter incorporates:
1. Indications for blood culture collection including number of specimens and timeframe
2. Type and order of specimens as well as discard volume
3. Collection equipment
4. Collection technique including Standard Precautions
5. Skin preparation using alcoholic chlorhexidine
6. Blood culture bottle inoculation
Culturing of PICC Sites & Tips
A procedure for culturing of catheter tips incorporates:
1. Indications for culturing of PICC sites and tips
2. Skin preparation including alcoholic chlorhexidine prior to catheter removal
3. Method of removal for specimen collection
Removal of PICC
Procedure for removal of PICC incorporates:
1. Personal protective equipment
2. Patient position
3. Skin preparation
4. Catheter removal
5. Dressings and site observations until site healed
Other (facility-specific)

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