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Central Line Dressing Change

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Overview

  1. Purpose
    1. Central line dressings changes should be done every 7 days or as needed for peeling or soiling
    2. This includes PICC lines
    3. Sterile technique must be maintained to prevent Central-Line Associated Blood Stream Infections (CLABSI)

Nursing Points

General

  1. Supplies needed
    1. Central Line Dressing Kit
      1. Large transparent dressing
      2. Tape
      3. Antiseptic swabs
        1. Usually a pack of 3
      4. Biopatch
      5. Mask
      6. Sterile gloves
    2. Mask for client
    3. Tape
    4. Clean gloves
    5. New injection caps

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Gather supplies
    2. Explain procedure to patient
    3. Perform hand hygiene
    4. Don clean gloves
    5. Apply mask to self and patient
    6. Instruct patient to keep their head turned away
    7. Carefully remove existing dressing towards insertion site (in the direction it was inserted)
      1. This prevents accidentally pulling the catheter out
    8. If using a securement device, remove it at this time and use a single piece of tape to secure the line in place
    9. Inspect placement site for signs of infection
    10. Ensure the patient’s hair and gown are out of the way of the dressing site
    11. Remove clean gloves
    12. Perform hand hygiene
    13. Open sterile dressing change kit using sterile technique
      1. Setup  open kit on bedside table so that you can reach supplies without turning your back
    14. Apply sterile gloves
      1. See Sterile Gloves lesson
    15. Use antiseptic swabs (3) to clean the site in the following 3 ways
      1. Scrub vertically from left to right
      2. Scrub horizontally from top to bottom
      3. Scrub in a circular motion from the center outward
      4. **Note – the friction from scrubbing is the only way to remove bacteria from the skin
      5. MUST let dry!
    16. If using a securement device, apply it at this time – use skin prep if appropriate
    17. Apply new biopatch
      1. “Blue to the sky”
      2. Per manufacturer instructions
      3. Around and under catheter, but slit should still be right under the catheter to prevent accidental dislodgement
    18. Apply new transparent dressing
    19. Secure central line with an extra piece of tape if necessary
    20. Change infusion caps, ensuring that the lines are CLAMPED and that the new caps are primed with saline before flushing the line
    21. Time, date and initial the dressing
    22. Discard all used supplies in appropriate waste containers
    23. Remove gloves
    24. Perform hand hygiene
    25. Return bed to low/locked position
    26. Ensure patient is comfortable
    27. Document procedure and patient response/tolerance

Patient Education

  1. Purpose for procedure
  2. Importance of holding still and facing away from site to prevent infection

Reference Links

Study Tools

Video Transcript

In this video we’re going to talk about central line dressing changes. In this particular video, we’re going to look at a PICC Line, but the same strategy is also used for a Central Line. Remember the dressing should be changed every 7 days or as needed.

First things first, once you’ve gathered your supplies on the bedside table, you’re going to apply a mask to yourself and your patient. Now, sometimes the kit comes with a mask inside of it, but I always grab extra masks and do this step first, just for safety and infection control purposes.
Make sure you tell your patient to keep their head turned while you remove the existing dressing. You want to remove it toward the insertion site to prevent it from accidentally pulling out.
If you have any kind of securing device, like a stat lock for a PICC line, remove it at this time and use a single piece of tape to secure the line in place.
While you have the dressing off, make sure you inspect the site for signs of infection.
Now you’re going to remove your clean gloves and wash your hands. Then you can open your sterile dressing change kit.
You want to set up open kit on bedside table so that you can reach all of your supplies without turning your back. Sometimes I actually put the table closer to the head of the bed, so it stays in front of me.
Then you want to apply your sterile gloves. If you need more guidance on how to do this, specifically, check out the sterile gloves lesson for details on that.
The next thing you’re going to do is find the antiseptic swabs in your kit. There are usually 3 of them. You’re going to use all 3 of them to clean the site. First one you’ll scrub vertically from left to right, the second one you’ll scrub horizontally from top to bottom, then with the last one you’ll scrub in a circular motion from the center outward.
Remember that friction from scrubbing is the only way to remove bacteria from the skin and that you MUST let it dry. Don’t wave it or blow on it, just let it dry – that’s when the bacteria die.
If you have a specific securement device, you will apply it at this time. If the kit comes with skin prep, use that before you place the device. Every device is different. So make sure you familiarize yourself with how to place and remove the device your facility uses. You can also remove your other piece of tape now that it’s secure.
Now you’re going to apply a new biopatch. We like to remember “blue to the sky”, but again make sure you’re following manufacturer instructions.
The slit should go around the catheter and sit under it, but don’t twist it around, otherwise you could risk the catheter being pulled out when you pull the dressing off.
Speaking of dressing – it’s time! So you can take your big tegaderm dressing and apply it over the site. Sometimes they will have these extra pieces of tape on them as well, so you can use those to secure your line.
These tegaderms are actually activated with heat and friction, so give it a little press and rub to make sure it sticks!
In most cases, you’ll also change your infusion caps at this time, too, depending on your facility policy. Just make sure that the lines are CLAMPED and that the new caps are primed with saline before you flush the line.
Finish off by time, date and initialing the dressing. Then discard your supplies and document what you did!
That’s it! It is a sterile procedure, but don’t let it intimidate you! You guys are gonna be amazing at this!

Now, go out and be your best selves today. And, as always, happy nursing!

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