Triple Lumen
1. Secure catheter with
2. Cover site and
StatLock* catheter
StatLock* catheter
stabilization device.
stabilization device
with transparent
dressing.
Tape Strip Securement Procedure
Single Lumen
Dual Lumen
1. Place 1st anchor
2. Cover site and 1st
tape over wings or
anchor tape with
bifurcation.
transparent dressing
up to hub, but not
over hub.
Triple Lumen
1. Place 1st anchor
2. Cover site and 1st
tape over wings or
anchor tape with
trifurcation.
transparent dressing
up to hub, but not
over hub.
Flushing the Catheter
If you are caring for your catheter, you will be taught the right way to flush your catheter.
Your catheter should be flushed _____________________________________________.
It should be flushed with ___________________________________________________.
Catheter Information
Patient Name: ____________________________________________________________
Your (patient's) Phone Number: ______________________________________________
Primary Doctor's Name:_____________________________________________________
Primary Doctor's Phone Number: _____________________________________________
IV Nurse Name: ___________________________________________________________
IV Nurse Phone Number: ___________________________________________________
Hospital: ________________________________________________________________
Hospital Phone Number: ___________________________________________________
Home Care Agency: _______________________________________________________
3. Place 1st anchor
4. Place 2nd and
tape sticky side up,
3rd anchor tapes
under one extension
sticky side up
leg. Wedge tape
under remaining
between hub and
hubs. Wedge tape
wings. Chevron
between hubs and
anchor tape on
wings. Chevron
top of transparent
anchor tape on
dressing.
top of transparent
dressing.
3. Place 2nd anchor
4. Chevron 2nd anchor
tape sticky side
tape on top of
up under hub and
transparent dressing
close to transparent
and place 3rd anchor
dressing. Wedge
tape over hub.
tape between hub
and wings. Anchor
only one hub of dual
lumen catheter.
3. Place 2nd anchor
4. Place 2nd and
tape sticky side
3rd anchor tapes
up under hub and
sticky side up
close to transparent
under remaining
dressing. Wedge
hubs. Wedge tape
tape between hub
between hubs and
and wings. Chevron
wings. Chevron
anchor tape on
anchor tape on
top of transparent
top of transparent
dressing.
dressing.
Home Care Agency Phone Number: __________________________________________
Date Inserted: ____________________________________________________________
Inserted By:______________________________________________________________
Catheter Lot Number: _____________________________________________________
Catheter Length (after trimming):___________________cm French Size: 4 5 6
Your catheter was threaded approximately______________________________cm
into the________________________________________________vein.
By external measurement, the tip of the catheter is in the _________________________.
Your doctor may request an x-ray to check the exact location of the tip of the catheter.
X-Ray Done: Yes No
You will be receiving the following medications through your PowerPICC* catheter.
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Catheter Maintenance Schedule
Directions: List the data below and check off the actions performed.
Catheter
Bandage
Date
Change
X
Catheter Problems
You may notice a small red bump at the place where your catheter was inserted.
This is normal, however, you should feel no pain or see any drainage after the first
bandage change.
Call your doctor or nurse right away if you notice:
1. A lot of bleeding or drainage where the catheter comes out of your arm.
2. Redness or swelling where the catheter comes out of your arm.
3. Pain, soreness or swelling of the arm with the catheter.
4. Pain or discomfort when IV solution fluids are put into your catheter.
5. Chest pain or discomfort while your catheter is in place.
6. Catheter movement either in or out of its place in your arm.
7. If you have a catheter leak or accidentally break or damage the catheter, fold and
tape the catheter between the break or leak and where the catheter comes
out of your arm.
NOTE: Any of these changes in or around your catheter could be very serious. You
should contact your doctor or nurse as soon as you see any problems like those
described above.
3
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Extension
Injection
Tubing
Cap
Flushing
Change
Change
Amount
X
X