Central Venous Line Dressing Change

<< CARDIOVASCULAR

*NOTE:  This procedure is commonly performed by a licensed registered nurse.

Considerations:

  • The use of this procedure guideline assumes that the registered nurse has the nursing education and skills to perform this task. This procedure guideline does not replace nursing clinical judgment. The registered nurse should contact the student’s health care team for guidance on how to perform this procedure.
  • A central venous line dressing change would not be considered a routine procedure in the school setting and should only be completed if the catheter site dressing becomes damp, loosened, or visibly soiled
    • This is a complex procedure that requires the registered nurse to have the necessary education, training and experience to perform this procedure
    • This procedure requires additional resources including a second person to assist with the procedure, 30 minutes of uninterrupted time, and the ability to perform this procedure using Aseptic non touch technique (ANTT®).
    • If the registered nurse does not have the capability to perform this procedure then the registered nurse should discuss with the student’s parents/guardians and health care provider to arrange a different plan
  • If there is a risk for dislodging the catheter, do not change the dressing, reinforce the dressing and call parents/guardian and healthcare provider
  • Determine the need for assistance of another person to hold or comfort the student while performing the procedure to ensure that sterile technique is maintained throughout the procedure.
  • Best practice is to have two adults present for the dressing change.
  • Adhere to Aseptic non touch technique (ANTT®)  when providing site care and dressing changes on venous access devices.
  • Be sure to take steps to ensure student’s privacy when performing procedure.
  • Student should have an emergency kit readily available at all times (including field trips).
  • Student’s Individualized Healthcare Plan should include documentation of the external catheter length and the external catheter length should be verified and documented during dressing change (see Step 29).

Considerations:

  • Be sure to take steps to ensure student’s privacy when performing procedure
  • Student should have an emergency kit readily available at all times (including field trips)

Supplies:

  • Healthcare provider’s orders
  • Parent/Guardian authorization form
  • Student’s Individualized Healthcare Plan
  • Non-sterile gloves
  • Chlorhexidine catheter dressing kit:
    • Sterile gloves
    • Mask
    • No sting barrier
    • 2% chlorhexidine gluconate in 70% isopropyl alcohol, Povidone iodine swabsticks, or student specific cleaning supplies
    • Alcohol wipes
    • Sterile gauze
    • Sterile transparent occlusive dressing
    • Adhesive tape
    • Hand sanitizer
    • Adhesive remover
    • Biopatch
    • Tape measure
    • Dressing label
    • Stabilization device, if used
  • Emergency Kit:
    • Chlorhexidine kit
    • Catheter cap
    • Stat lock
    • Clean gloves
    • Flushing supplies:
      • 70% isopropyl alcohol wipes
      • 10 ml syringes
      • Heparin flush

Procedure Download
Skill Competency Download

Procedure:

  1. Review healthcare provider’s order
    • Note the external catheter length measurement that is documented in student’s healthcare record so you can verify that the catheter is the correct length later during the procedure (see step 29)
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Clean your workstation with soap and water or disinfectant wipeGather supplies and place on a clean surface
  4. Gather supplies and place on a clean surface
  5. Explain the procedure to the student at their level of understanding
  6. A second person should be available to assist with the dressing change
  7. Have student put on a mask or turn their head to the side to avoid breathing directly on the catheter insertion site
  8. Put on mask, if someone is assisting in procedure, have that person put on mask as well
  9. Wash hands, if someone is assisting in procedure, have that person wash hands as well
  10. Have assistant put on clean gloves
  11. Assist student in removing clothing to uncover the dressing
  12. Position the student
    • Student may be sitting or lying flat
  13. Open the catheter dressing kit on a clean work surface being careful to keep the inside of the catheter dressing kit and it’s contents sterile
  14. Put on clean gloves
  15. Assess the insertion site through the old dressing
    • Observe for redness, swelling, or fluid drainage
    • Gently palpate the site, noting pain, tenderness, or discomfort
  16. Remove wet or soiled dressing from the catheter exit site, dispose per school policy
    • Gently pull the dressing perpendicular to the skin toward the insertion/exit site
      • Avoid inadvertently dislodging the catheter, as it may be adhered to the dressing
      • Be sure to maintain skin integrity and prevent venous access device dislodgement (i.e. avoiding rapid and/or vertical pulling or insufficient support of skin when removing the dressing
  17. Remove securement device or product per manufacturer’s instructions
  18. Remove clean gloves
  19. Wash hands
  20. Put on sterile gloves
    • Steps 19-27 should be completed using sterile technique
  21. Clean the skin with a 2% chlorhexidine gluconate in 70% isopropyl alcohol swabstick (or cleaning agent per health care provider’s order) covering at least 2- to 3- inch area
    • Apply chlorhexidine using a gentle back and forth motion
    • Clean the skin for at least 30 minutes
    • Do not wipe or blot
  22. Allow the area to dry completely before proceeding (at least 30 seconds)
    • Do not blow or fan the area
  23. Dispose of swabstick in garbage
  24. Clean the catheter:
    • Hold catheter at distal end of exit site (away from skin)
    • Use another alcohol wipe or swabstick to clean the catheter
    • Wipe or swab around the catheter at the exit site and work it toward the injection cap
  25. Apply skin barrier solution, if ordered
  26. Apply Biopatch disk on exit site with blue side up, if ordered
    • Make sure skin is thoroughly dry before placing Biopatch disk on the skin to prevent reaction
  27. Apply new securement device or product
  28. Place transparent dressing or other type of dressing per healthcare provider’s order on catheter insertion site
    • Press around the edges of the bandage to form a seal
  29. Verify external catheter length
    • Contact parents/guardian and healthcare provider if exit markings differ from information documented on insertion
  30. Secure the catheter, as needed
  31. Label the dressing with the date, time, and initials
    • Be sure to avoid placing the label over insertion/exit site
  32. Assist student in dressing
  33. Remove mask
  34. Remove gloves and discard mask and gloves in appropriate receptacle
  35. Encourage student to report any changes in their catheter site or any new discomfort to their parents/guardian and healthcare provider
  36. Document assessment, intervention, and outcome in student’s healthcare record
  37. Follow up with parent/guardian and healthcare provider, as needed

Emergency care:

If the catheter comes out:

  1. Wash hands
  2. Put on gloves
  3. Hold firm pressure over the site for at least 5 minutes
  4. Apply antibacterial ointment and cover it with gauze and tape
  5. Call parents/guardian and student’s healthcare provider immediately

References:

Association for Vascular Access. (2019). Guidance document. Standardizing the critical clinical competency of aseptic, sterile, and clean techniques with a single international standard: Aseptic non touch technique (ANTT®). Retrieved August 3, 2023, from https://cdn.ymaws.com/www.avainfo.org/resource/resmgr/files/position_statements/ANTT.pdf

Infusion Nurses Society, Inc. (2021). Aseptic non touch technique (ANTT®). In Policies and procedures for infusion therapy: Home infusion. (2nd Ed.). (pp. 42-44).

Infusion Nurses Society, Inc. (2021). Vascular access device assessment, care, and dressing changes. In Policies and procedures for infusion therapy: Home infusion. (2nd Ed.). (pp. 131-138). 

Intravenous infusion treatment.  Missouri Code of State Regulations. Rules of department of commerce and insurance. Division 2200–State board of nursing chapter 6–administration. (2019). Retrieved June 20, 2023, from https://www.sos.mo.gov/cmsimages/adrules/csr/current/20csr/20c2200-6.pdf

Lynn, P. (2019). Changing the dressing and flushing central venous access device. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 355-357).

O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., Masur, H., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A. G., Rupp, M. E., Saint, S., & Healthcare Infection Control Practices Advisory Committee (HICPAC). (2011, updated 2017). Summary of recommendations: Guidelines for the prevention of intravascular catheter-related infections. Retrieved June 9, 2023, from https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf

Pediatric Home Services. (2015). Bandage change on a central IV catheter (Cambio del apósito para el catéter intravenoso central). . Accessed June 9, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/bandage-change-on-a-central-iv-catheter/?play=1

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Managing central venous access devices. In Clinical nursing skills and techniques. (10th ed.). (pp. 887-900). St. Louis, MO: Elsevier.

Page last reviewed: March 4, 2025
Page last updated: March 4, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.