|Critical Performance Elements||YES||NO|
|1. Gather all necessary equipment: roll of tape, label, and central line line dressing kit.|
|2. Wash hands. Explain procedure to the patient and/or significant others. Check for providone-iodine or tape allergy.|
|3. Organize supplies and equipment at bedside to decrease the amount of time that site is open to air.|
|4. *** Open central line kit. Don mask. (Don gown if soiling is likely).|
|5. Place patient in supine position with head turned away from catheter insertion site to decrease potential for contamination by patient’s secretions. Place a mask over the patient’s mouth and nose or sterile drape over ventilated or trached patient.|
|6. *** Don a pair of clean gloves.|
|7. Remove present dressing carefully to minimize trauma and prevent accidental dislodgment of catheter. Discard soiled dressing in proper trash receptacle.|
|8. Visually inspect the skin and catheter site for signs of infection, leakage, or other mechanical problems.|
|9. *** Remove soiled gloves and don sterile gloves.|
|10. *** Working in a circular motion from insertion site outward to edge of dressing border cleanse skin, insertion site, and distal portion of catheter with :a. Providone-iodine scrub swabsticks x 3 – to remove bacteria and fungi.
b. Alcohol swabsticks x 3 – to remove the betadine scrub.
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Changing a Central Line Catheter Dressing
c. Betadine solution swabsticks x 3 to cover a 3″ x 6″ area from site to periphery- to provide protective barrier against pathogens. Blot excess or pooled solution. Allow to dry.
*** For patients with IODINE ALLERGY- If 4% chlorhexidine is used, remove it with alcohol swabs after a two to five minute dwell time.
|11. If a tubing change is necessary:a. Instruct the patient to perform Valsalva maneuver or hold his/her breath (or immediately after a ventilator delivers a breath).
b. Quickly disconnect and reconnect the IV tubing ensuring secure junction.
|12. *** Dressing- may use elastoplast or occlusive dressing as follows:a. Elastoplast:
b. Occlusive Dressing- (Tegaderm):
|13. *** Loop and secure IV tubing to dressing and arm or chest.|
|14. *** Label dressing with time, date of dressing change and insertion, and initials.|
|15. Discard supplies used. Wash hands.|
|17. *** Document the dressing change, the condition of the insertion site on nursing note and flow sheet. Document any problems encountered in nursing progress notes on.|
|NOTE: If 2×2 gauze used after initial insertion under occlusive (Tegaderm) dressing, dressing must be changed in 24 hours.|
*** Must perform these critical elements for successful completion.
Changing and flushing a central line access cap
- Check client’s chart and care plan to determine time of last access cap change.
- Identify client
- Explain procedure to client and provide privacy
- Gather equipment
- Wash your hand and don gloves
- Repeat procedure with the remaining access caps
- Remove gloves and wash hands
Reference: Infection Control Manual