Central Line Dressing Change
Indications for Central Venous Access Device:
- Cancer- chemotherapy, infusion of irritating or vesicant medications
- Infection- long term antibiotics
- Pain- long term pain medications
- Drugs at risk for phlebitis- epoprostenol, calcium chloride, potassium chloride, amiodarone
- Nutritional Replacement- PN, ability to infuse higher dextrose than with peripheral
- Blood samples & Blood transfusions
- Renal failure- hemodialysis
- Shock, burns- high volume of fluids and electrolyte replacement
- Hemodynamic monitoring- central venous pressure to assess fluid balance
- Heart failure & autoimmune disorders- ultrafiltration & plasmapheresis
- Infection- long term antibiotics
- Pain- long term pain medications
- Drugs at risk for phlebitis- epoprostenol, calcium chloride, potassium chloride, amiodarone
- Nutritional Replacement- PN, ability to infuse higher dextrose than with peripheral
- Blood samples & Blood transfusions
- Renal failure- hemodialysis
- Shock, burns- high volume of fluids and electrolyte replacement
- Hemodynamic monitoring- central venous pressure to assess fluid balance
- Heart failure & autoimmune disorders- ultrafiltration & plasmapheresis
Equipement:
- Sterile Dressing Kit
- Non-sterile Gloves
- Sterile gloves if size in kit is not fitted for hands (size is usually between 7-7 1/2)
- Mask
- Measuring tape (if not included in kit)
- Pen
- Tape (if needed to secure dressing more firmly)
- Non-sterile Gloves
- Sterile gloves if size in kit is not fitted for hands (size is usually between 7-7 1/2)
- Mask
- Measuring tape (if not included in kit)
- Pen
- Tape (if needed to secure dressing more firmly)
Assessment:
- Type of Central Line (Non-tunneled, Tunneled, Implanted port, or PICC)
- Baseline Vitals
- Signs of pain or tenderness (particularly in neck, chest, or arm), redness, swelling, warmth, or drainage.
- Allergies to tape
- Measure length of the catheter from skin to hub
- Notify physician of any abnormal conditions or changes.
- Baseline Vitals
- Signs of pain or tenderness (particularly in neck, chest, or arm), redness, swelling, warmth, or drainage.
- Allergies to tape
- Measure length of the catheter from skin to hub
- Notify physician of any abnormal conditions or changes.
Possible Complications:
- Catheter occlusion- signs of sluggish infusion, or unable to infuse or aspirate
- Embolism- chest pain, respiratory distress, hypotension, and tachycardia
- Infection- systemic- fever, chills, malaise. Local- redness, tenderness, edema, purulent drainage, or warmth.
- Pneumothorax- decreased or absent breath sounds, respiratory distress, chest pain, or distended unilateral chest.
- Catheter Migration- sluggish infusion or aspiration, edema of chest or neck during infusion, patient complains of gurgling sound in ear, dysrhythmias, or increased external catheter length.
- Embolism- chest pain, respiratory distress, hypotension, and tachycardia
- Infection- systemic- fever, chills, malaise. Local- redness, tenderness, edema, purulent drainage, or warmth.
- Pneumothorax- decreased or absent breath sounds, respiratory distress, chest pain, or distended unilateral chest.
- Catheter Migration- sluggish infusion or aspiration, edema of chest or neck during infusion, patient complains of gurgling sound in ear, dysrhythmias, or increased external catheter length.
Key Points:
- When removing dressing, hold catheter firmly in place with one hand, while removing the dressing with the other.
- Gauze dressing should be used for drainage or bleeding from site. Otherwise, a transparent dressing may be used.
- Patient must be wearing mask and facing opposite direction of central line during dressing change.
- Clean site with Chlorhexidine based preparations. Use a back and forth motion, not a circular motion for thirty seconds, applying appropriate friction. Let preparation air dry. DO NOT wave air over site to speed up drying process. This only leads to contamination of site and an increase chance of infection.
- If dressing kit only includes 1 swab of Chlorhexidine, continue care with alcohol swabs, cleaning in circular motion starting at the center and working outward to 4 inches in diameter.
- If dressing kit supplies 3 Chlorhexidine swabs, use all three and no alcohol swabs on site.
- Flush each port with 5-10 ml of saline. A 10 ml syringe or larger must be used. Anything smaller will produce too much pressure on catheter.
- Gauze dressing should be used for drainage or bleeding from site. Otherwise, a transparent dressing may be used.
- Patient must be wearing mask and facing opposite direction of central line during dressing change.
- Clean site with Chlorhexidine based preparations. Use a back and forth motion, not a circular motion for thirty seconds, applying appropriate friction. Let preparation air dry. DO NOT wave air over site to speed up drying process. This only leads to contamination of site and an increase chance of infection.
- If dressing kit only includes 1 swab of Chlorhexidine, continue care with alcohol swabs, cleaning in circular motion starting at the center and working outward to 4 inches in diameter.
- If dressing kit supplies 3 Chlorhexidine swabs, use all three and no alcohol swabs on site.
- Flush each port with 5-10 ml of saline. A 10 ml syringe or larger must be used. Anything smaller will produce too much pressure on catheter.
Post-procedure Assessment:
- Patient's reaction to dressing change
- Patient's level of pain
- Statement to patient of when the next dressing change will occur.
- Patient's level of pain
- Statement to patient of when the next dressing change will occur.
Documentation:
- Type of central line
- Assessment findings of central line site
- Reason for changing dressing (scheduled, too much drainage, etc.)
- Old dressing assessments
- Patient's reaction to procedure
- Length of catheter to hub
- Next scheduled dressing change
- Nurse's initials, date, and time of dressing in chart and on dressing.
- Any complication that occurred during the dressing change
- Assessment findings of central line site
- Reason for changing dressing (scheduled, too much drainage, etc.)
- Old dressing assessments
- Patient's reaction to procedure
- Length of catheter to hub
- Next scheduled dressing change
- Nurse's initials, date, and time of dressing in chart and on dressing.
- Any complication that occurred during the dressing change
Reference: Lewis, S. M. (2011). Fluid, electrolyte, and acid-base imbalances. Medical-surgical nursing: assessment and management of clinical problems. (8th ed., p. 328, 330, & 331). St. Loius, MO.: Elsevier/Mosby