Central Venous Line Dressing Change

<< CARDIOVASCULAR


  • 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

procedure download skill competency

  1. Review healthcare provider’s order
  2. Gather supplies and place on a clean surface
  3. Explain the procedure to the student at his/her level of understanding
  4. A second person should be available to assist with the dressing change
  5. Have student put on a mask or turn their head to the side to avoid breathing directly on the catheter insertion site
  6. Put on mask, if someone is assisting in procedure, have that person put on mask as well
  7. Wash hands, if someone is assisting in procedure, have that person wash hands as well
  8. Have assistant put on clean gloves
  9. Assist student in removing clothing to uncover the dressing
  10. Position the student
    • Student may be sitting or lying flat
  11. Open the catheter dressing kit on a clean work surface
  12. Put on clean gloves
  13. Remove wet or soiled dressing from the catheter exit site, dispose per school policy
  14. Inspect the area around the catheter for redness, swelling, or fluid drainage
  15. 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
  16. Remove clean gloves
  17. Wash hands
  18. Put on sterile gloves
  19. 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
  20. Allow the area to dry completely before proceeding
    • Do not blow or fan the area
  21. Dispose of swabstick in garbage
  22. Repeat the cleaning process two more times, for a total of three cleanings, using a new swabstick for every cleaning
  23. 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
  24. If a PICC line is in place:
    1. Open wings, and remove Stat lock using alcohol cleansing product
    2. Cleanse skin beneath wings where Stat lock was with appropriate cleaning solution
    3. After applying no-sting barrier skin prep to the skin to be covered by dressing
    4. Secure line to skin with new Stat lock and close wings
  25. 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
  26. Place transparent dressing or other type of dressing per healthcare provider’s on catheter insertion site
  27. Assist student in dressing
  28. Remove gloves, discard in appropriate receptacle
  29. Encourage student to report any changes in their catheter site or any new discomfort to their parents/guardian and healthcare provider
  30. Document assessment, intervention and outcome in student’s healthcare record
  31. 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:

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