- 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
- If there is a risk for dislodging the catheter, do not change the dressing, reinforce the dressing and call parents/guardian and healthcare provider
- Best practice recommends having two adults present for the dressing change
Considerations:
- Be sure to take steps to ensure student’s privacy when performing 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
- 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
- Student should have an emergency kit readily available at all times (including field trips)
Supplies:
Healthcare provider’s orders
Chlorhexidine catheter dressing kit:
- Sterile gloves
- Mask
- No sting barrier
- Alcohol swabsticks
- 2% chlorhexidine gluconate in 70% isopropyl alcohol, Povidone iodine swabsticks, or student specific cleaning supplies
- Alcohol wipes
- Sterile gauze
- Transparent occlusive dressing
- Adhesive tape
- Hand sanitizer
- Adhesive remover
- Biopatch
Emergency Kit:
- Chlorhexidine wipes or swabs
- Injection cap
- Clean gloves
- Flushing supplies:
- 2% chlorhexidine gluconate in 70% isopropyl alcohol
- 10 ml syringes
- Saline or Heparin flush, if ordered
- Catheter dressing kit:
- Sterile gloves
- Mask
- Alcohol swabsticks
- 2% chlorhexidine gluconate in 70% isopropyl alcohol, Povidone iodine swabsticks, or student specific cleaning supplies
- 2% chlorhexidine gluconate wipes
- Sterile gauze
- Transparent occlusive dressing
- Adhesive tape
- Extra clamp
- Review healthcare provider’s order
- Gather supplies and place on a clean surface
- Explain the procedure to the student at his/her level of understanding
- A second person should be available to assist with the dressing change
- Have student put on a mask or turn their head to the side to avoid breathing directly on the catheter insertion site
- Put on mask, if someone is assisting in procedure, have that person put on mask as well
- Wash hands, if someone is assisting in procedure, have that person wash hands as well
- Have assistant put on clean gloves
- Assist student in removing clothing to uncover the dressing
- Position the student
- Student may be sitting or lying flat
- Open the catheter dressing kit on a clean work surface
- Put on clean gloves
- Remove wet or soiled dressing from the catheter exit site, dispose per school policy
- Inspect the area around the catheter for redness, swelling, or fluid drainage
- For peripherally inserted central venous catheters and midline catheters, verify external catheter length
- Contact parents/guardian and healthcare provider if exit markings differ from information documented on insertion
- Remove clean gloves
- Wash hands
- Put on sterile gloves
- Clean the skin with a 2% chlorhexidine gluconate in 70% isopropyl alcohol swabstick (or cleaning agent per healthcare provider’s order), starting at the center, closet to the insertion site, and working outward in widening circles
- Clean the skin for at least 30 seconds
- Allow the area to dry completely before proceeding
- Do not blow or fan the area
- Dispose of swabstick in garbage
- Repeat the cleaning process two more times, for a total of three cleanings, using a new swabstick for every cleaning
- Clean the catheter:
- Hold an alcohol wipe or sterile gauze around the catheter at the exit site to prevent pulling
- 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
- If a PICC line is in place:
- Open wings, and remove Stat lock using alcohol cleansing product
- Cleanse skin beneath wings where Stat lock was with appropriate cleaning solution
- After applying no-sting barrier skin prep to the skin to be covered by dressing
- Secure line to skin with new Stat lock and close wings
- Apply Biopatch disk on exit site with blue side up
- Make sure skin is thoroughly dry before placing Biopatch disk on the skin to prevent reaction
- Do not blow or fan the area
- Place transparent dressing or other type of dressing per healthcare provider’s on catheter insertion site
- Assist student in dressing
- Remove gloves, discard in appropriate receptacle
- Encourage student to report any changes in their catheter site or any new discomfort to their parents/guardian and healthcare provider
- Document assessment, intervention and outcome in student’s healthcare record
- Follow up with parent/guardian and healthcare provider, as needed
Emergency care:
If the catheter comes out:
- Wash hands
- Put on gloves
- Hold firm pressure over the site for at least 5 minutes
- Apply antibacterial ointment and cover it with gauze and tape
- Call parents/guardian and student’s healthcare provider immediately
References:
Bianco, A., Coscarelli, P., Nobile, C.G.A., & Pileggi, C. (2013). The reduction of risk in central line-associated bloodstream infections: Knowledge, attitudes, and evidence-based practices in health care workers. American Journal of Infection Control , 41, 107-12
Casey, A.L. & Elliott, T.S.J. (2010). Prevention of central venous catheter-related infection: update. British Journal of Nursing, 19,2.
Children’s Hospitals and Clinics of Minnesota. (2010). Central Venous Catheter: Care at Home. Available at: http://www.childrensmn.org/manuals/pfs/homecare/018325.pdf
Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at: http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf
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., Rupp, M.E., Saint, S. (2011). Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta (GA): Centers for Disease Control and Prevention (CDC), 83, 370
Pavia, M. (2012). National Institute for Health and Clinical Excellence (NICE). Infection. Prevention and control of healthcare-associated infections in primary and community care. London (UK): National Institute for Health and Clinical Excellence (NICE), 47 p.
Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624
Acknowledgment of Reviewers:
Meghan Belongia, MSN, APNP, CPNP
Pediatric Hematology/Pediatric Oncology
Children’s Hospital of Wisconsin
Rachel Gallagher, RN, MSN, CPNP, NCSN
Director of Health Services
Milwaukee Public Schools
Renee Harteau, RN
Pediatric Hematology/Pediatric Oncology
Children’s Hospital of Wisconsin
Jill Krueger, RN, BSN
Director/Health Officer
Forest County Health Department
Page last reviewed: December 21, 2015
Page last updated: December 21, 2015