Definition
Changing dressing at a central venous catheter (CVC) insertion site is a high-stakes, sterile procedure that helps prevent central line-associated bloodstream infections (CLABSIs).
Purposes
- Maintain sterility at the catheter site
- Prevent infection, dislodgement, and skin breakdown
- Allow for site inspection and securement
Article
- A sterile dressing tray containing the following:
- Artery forceps (2 Nos.)
- Thumb forceps (1 No.)
- Cotton swabs.
- Gauze pieces.
- Gallipot.
- Betadine solution/swabs.
- Betadine ointment.
- Clean gloves.
- Sterile gloves.
- Adhesive tape and scissors for fixing the dressing
- Label with date and timing of dressing change.
- Face mask
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Provide explanation to client about dressing change and the need for it. | Patient cooperates and relaxes. |
| 2 | During procedure Assemble the articles near bedside. Wash hands and put on clean gloves | Reduces the number of microorganisms. |
| 3 | Remove old dressing with care not to dislodge the central venous catheter in the direction of the insertion. | Provides for observing the insertion site. |
| 4 | Note presence of any drainage on dressing. | Denotes bleeding or infectious material. |
| 5 | Inspect skin at insertion site for redness, tenderness, or swelling | Presence of these signs indicates infection. |
| 6 | Visually inspect catheter from hub to skin. | Checks whether catheter has a crack or is split or cut. |
| 7 | Remove gloves and put on sterile gloves | Prevents transmission of microorganisms from skin to exit site. |
| 8 | Clean exit site in a circular manner, for about 3 cm with betadine swab and alcohol (spirit) | Eliminates microorganisms by chemical and mechanical means. |
| 9 | Apply betadine ointment or CHG (Chlorhexidine gluconate) to exit site as per hospital policy. Recent practices also involve applying Biopatch on all central line insertions which are changed when the dressing is changed (every 7 days). The printed side or the shiny side is placed facing upwards. Biopatch is especially applied on tunneled long-term central venous catheters and should not be in pediatric patients having weight less than 1000 g or on those patients who have a compromised skin integrity. | Reduces growth of bacteria at exit site. |
| 10 | Apply a label with date and time of dressing change Apply transparent dressing | Documents time to plan for next change. Prevents bacteria from entering the exit site. |
| 11 | Secure tubing to clients clothing. | Prevents accidental displacement. |
| 12 | After procedure 12. Remove gloves and dispose off all used materials. | Reduces transmission of microorganisms. |
| 13 | Clean and replace the reusable items. | Keep articles ready for next use. |
| 14 | Wash hands. | Reduces transmission of microorganisms. |
Special Considerations
- Change dressing every 7 days (or sooner if soiled, loose, or damp)
- Never apply dressing over wet or irritated skin
- Avoid stretching transparent dressings—can cause skin tears
- Use aseptic technique throughout
- If signs of infection are present, notify provider and obtain culture
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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