Central Venous Dressing Change Policy

OBJECTIVE

To minimize the risk of catheter infection by providing a uniform technique for dressing changes.

SCOPE

Registered Nurse (RN) and Physician

DEFINITION

A Central Venous Catheter (CVC) includes both tunneled (Hickman, Broviac, Pheresis, Powerline PICC) and non-tunneled (Subclavian  Femoral, Internal Jugular) catheters

POLICY

The IV Team, Nutrition Support Nurse, and appropriately educated RNs and physicians  will change dressing according to the following guidelines:

§  All dressings will be inspected daily.  Replace dressing when it becomes damp, loosened, or when inspection of the site is necessary.

§  Dressings will be changed every 48 hours and as needed for gauze dressing; every 7 days and as needed for transparent dressing. 

§  The initial Broviac catheter transparent dressings are not to be changed for 7 days without the written order of the surgeon who inserted the line. 

PROVISIONS

Equipment List

Obtain dressing change tray.  Contents include:

Ÿ   (1) - Mask

·          (1) – Sterile non-latex gloves

·         (1) - 2 x 2 inch pre-split gauze

·         (1) - Triple alcohol swabsticks

·         (1) ChloraPrepp swab

·         (1) - Skin protectant prep pad

·         (2) - Alcohol pads

·         (1) - Transparent dressing 4 x 4  3/4 inch

·         (1) - Transparent dressing 2 3/8 x 2 3/4 inch

·         (1) - CSR wrap (may be used as a sterile field)

Additional Supplies Needed

§  1 StatLock Securement device

§  1 Pack skin closures (steri-strips)

§  1 pair non-sterile gloves

§  1 mask for patient and additional mask for helper when needed

§  1 BioPatch antimicrobial dressing

Various dressing kits contain only a portion of the needed supplies

NOTE:  If any break in sterile technique should occur, STOP, obtain a second set of supplies and start the procedure again.

PROCEDURE for Hickman, Broviac, Subclavien, Femoral, Internal Jugular catheters

1.     Explain procedure to patient/family.

2.     Identify correct patient using two unique identifiers, such as patient name, date of birth or medical record number.  See I CLN 044 Patient Identification.

3.     Perform hand hygiene with alcohol handrub or approved soap.

4.     Put on a facial mask.

5.     Open dressing change kit.

6.     Have patient wear a mask or turn his head away from exit site during dressing change..

7.     Put  on a pair of non-sterile gloves.

8.     Carefully remove old dressing stabilizing the catheter hub and using caution to NOT pull on the catheter. 

9.     Observe insertion site for signs of infection (redness, swelling, tenderness, drainage).

10.  Remove gloves,  Put on a pair of sterile gloves. 

11.  Clean the skin around the catheter exit site with ChloraPrep swab.  Use a back and forth friction scrub for 30 seconds.  Cleanse an area approximately 3-4 inches in diameter.  Do not touch site after prepping.  Allow to air dry for 30 seconds. 

12.  If patient is less than 2 months old or allergic to ChloraPrep, alcohol should be used.

A.    With an alcohol swab and starting at the exit site, sue a circular motion to move outward toward the periphery to cleanse an area approximately 3-4 inches in diameter.  DO NOT return to the exit site with the same swab.  Allow alcohol to air dry.  Do not blow on it or ware hand to aid drying.

B.    Repeat this cleaning procedure with the remaining two alcohol swabs.

C.    Hydrogen peroxide applied to a cotton tip applicator may be used prior to alcohol to loosen any crusting and/or drain care around the catheter exit site.

13.  Clean the catheter with alcohol pads.  Hold the catheter at the exit site with one alcohol pad; with the other alcohol pad clean the catheter in one motion from the exit site to the distal end, being careful not to pull on the catheter.

14.  Place BioPatch antimicrobial dressing (blue side up) at catheter exit site per manufacturer’s instructions.

15.  Wipe skin with protective prep pad in a square approximately the size of the transparent dressing edges and allow to air dry.

16.  Coil the Broviac catheter.  All other catheters should not be coiled.

A.    Holding the hub of the catheter with the alcohol pad, coil it slightly around the exit site to prevent dangling and kinking.

B.    If a gauze dressing is required, take pre-cut 2 x 2 non-adherent dressing and apply it around the exit site, then coil the catheter and cover with 2 x 2 dressing.

17.  Apply transparent dressing over catheter, making sure dressing is secure.  May take protective prep pad and wipe over periphery of transparent dressing.

PROCEDURE for Powerline, PICC and Pheresis catheter

1.     Explain procedure to patient/family.

2.     Identify correct patient using two unique identifiers, such as patient name, date of birth or medical record number.  See I CLN 044 Patient Identification.

3.     Perform hand hygiene with alcohol handrub or approved soap.

4.     Put on a facial mask.

5.     Open dressing change kit.

6.     Have patient wear a mask or turn his head away from exit site during dressing change..

7.     Put on a pair of non-sterile gloves.

8.     Carefully remove old dressing and StatLock using caution not to pull on the catheter.

9.     Observe insertion site for signs of infection (redness, swelling, drainage)

10.  Remove gloves.  Put on sterile gloves.

11.  Clean the skin around the catheter exit site with ChloraPrep swab.  Use a back and forth friction scrub for 30 seconds.  Cleanse an area approximately 3-4 inches in diameter.  Do not touch site after prepping.  Allow to air dry for 30 seconds.

12.  If patient is less than 2 months old or allergic to ChloraPrep, alcohol should be used.

A.    With an alcohol swab and starting at the exit site, sue a circular motion to move outward toward the periphery to cleanse an area approximately 3-4 inches in diameter.  DO NOT return to the exit site with the same swab.  Allow alcohol to air dry.  Do not blow on it or ware hand to aid drying.

B.    Repeat this cleaning procedure with the remaining two alcohol swabs.

C.    Hydrogen peroxide applied to a cotton tip applicator may be used prior to alcohol to loosen any crusting and/or drain care around the catheter exit site.

13.  Apply protectant prep pad to StatLock placement site.  Allow skin prep to dry for 10-15 seconds (Do not wipe    near catheter exit site.)  Allow to air dry.

14.  Place Catheter wing securement holes over posts and close the StatLock plastic doors one at a time.  For        sliding posts place one catheter wing securement hold over either post then slide to capture the other post.

15.  Peel away the release liner from the back of the pad, one side at a time and secure the pad over the     selected site.

16.  Place BioPatch antimicrobial dressing (blue side up) at catheter exit site per manufacturer’s instructions.

17.  Wipe skin with protectant prep pad in a square approximately the size of the transparent dressing edges and    allow to air dry.

18.  Apply large transparent dressing over entire exposed catheter and hub.  The exit site must be visible through     the dressing.  Secure dressing to skin.  May take protectant prep pad and wipe over periphery of dressing.

19.  If a T-connector is used it should be considered part of the catheter and included under the transparent             dressing.  It should not be changed routinely.

Documentation

1.     Date, time, initial the dressing. 

2.     Document procedure on EMR AdHoc IV form.

References
 Central Venous Catheter:Dressing Change. Retrieved on March 12, 2011 from Detroit Medical Centers Policy website: https://extraweb.dmc.org/default.aspx?ifsrc=/main_dmcinfo/policies/default.asp?col=1