Device Maintenance, Care, and Removal
Domain 8: Device Maintenance, Care, and Removal
This domain tests daily care that keeps devices patent and safe, and removal when the indication ends.
Core rules
- Assess site and device every shift or visit: redness, swelling, pain, drainage, catheter length, dressing integrity, and function.
- Dressings: sterile, semipermeable, secure; change if soiled, loose, or per policy. Use chlorhexidine-based antisepsis and allow drying. Avoid tension and moisture trapping.
- Flush with preservative-free saline using a pulsatile technique and positive pressure. Use the correct syringe size; small syringes generate high pressure and can damage catheters. Do not force against resistance.
- Lock solutions follow device and policy; heparin is not universal and may be contraindicated.
- Blood sampling: discard, sample, flush; avoid excessive vacuum.
- Remove when no longer indicated, if infected, thrombosed, or damaged. For PICC or CVC removal, place patient supine or head-down if tolerated, remove dressing, withdraw gently, apply haemostasis, inspect catheter tip, and document.
- Routine replacement of peripheral IVs is not required solely for dwell time; replace for clinical indications.
Worked example
A PICC dressing is soiled at day 5. Reasoning: change it using sterile technique, chlorhexidine-alcohol, and a new securement device. Do not simply tape over it. If the catheter has migrated outward, do not push it back; obtain imaging and reassess.
Traps
Flushing forcefully; using scissors near the catheter; routine PIV replacement by calendar; missing a retained tip; and discharging without a dressing plan.