Central Line Dressing Change: Preparation and Pre-procedure (Nursing)

00:04 Welcome to Central Line Dressing Change.

00:07 Now, before we get started, let's talk about a quick anatomy review.

00:11 Now when you look at a central line, you may see the most commonly in either the neck which may be in the jugular vein or the patient's chest, which would be the subclavian vein.

00:21 Now, let's talk about our equipment we're going to need.

00:24 Now, here's a couple of considerations before you go into the room is make sure you grab a regular pair of gloves.

00:31 We're going to need these remove the old dirty dressing.

00:34 And make sure you grab your catheter tips as well.

00:38 This may be indicated if your policy directs you that these have to be changed with each dressing change.

00:45 A couple other considerations are that with a dressing kit, sometimes there's only one mask in there for you.

00:52 You may want to also grab an additional mask for your patient as well.

00:57 Now, a Bio-patch is something that we use as an antimicrobial disk on the insertion site itself.

01:05 Some kits have these in them, some kits don't.

01:07 But make sure you grab this if your facility has this.

01:10 And next we have an antimicrobial cap.

01:14 This is really great because this is going to help reduce central line infections.

01:18 Now, this is going to go on the catheter tip itself for disinfecting purposes.

01:25 Now, let's talk about our Central line dressing kit itself.

01:29 There's quite a few things in here, so I'm going to walk you through them.

01:32 Now, we talked already that the surgical mask actually comes in the kit itself.

01:37 But this is typically for you as the one performing the skill.

01:41 Now, next, is you're going to have a pair of surgical gloves.

01:44 Now, you may want to get familiar with your kit because the gloves that come in here are fairly small and it's a one standard size.

01:52 If these don't fit you, you may need to bring an additional or an appropriate size with you as well before you start your skill with the patient.

02:00 Now, the other thing that comes in the kit is a surgical drape.

02:04 This is going to be really important on a hard flat surface to create a surgical sterile field for you so you can put out your equipment to use.

02:13 Now, we talked about that biopatch, some kits may have those, but you just want to make sure if your facility has them to grab that and check your kit.

02:22 Now, one thing that's also very common is your tegaderm dressing that goes over the site.

02:26 So, we want to ensure that that's in there.

02:28 So this is what this is going to look like.

02:30 Now, inside the kit, there are some options in regards to cleaning.

02:35 Now, sometimes you're going to see something very commonly such as alcohol as swab sticks.

02:40 These are pretty common of what you're going to see especially in your lab as a student to cleaning the insertion site in the catheter itself.

02:48 Now, in hospitals, we really love to use a ChloraPrep which looks a lot like this.

02:53 I'm going to go ahead and open this for you.

02:56 The ChloraPrep is something we like to use for cleaning.

02:59 So, in the hospital, you may use something like this for cleaning.

03:03 Now, one thing I want to address in a lot of the central line kits, you're going to see some gauze dressings.

03:09 Now, you might see gauze dressings are indicated for certain reasons for a patient's.

03:15 But most policy nowadays, guidelines direct us that we don't put gauze underneath the dressing.

03:21 We try to avoid that because that's just another breeding ground for bacteria.

03:26 Now, we also have a set of tweezers that also come in with your kit.

03:29 This is really helpful when you actually need to grasp the central line and clean underneath it and the line itself.

03:35 You may also have a couple of pads in here too.

03:39 So, you may have like a skin prep, or like an alcohol pad like this.

03:44 This is going to help prep the skin before you put your tegaderm dressing on.

03:49 One other thing that you might see. Now, this is a little bit different, but you're going to see a measuring tape most commonly in a central line dressing kit.

03:57 It's pretty common in central lines or even really PICC lines.

04:01 You may need to use this to measure the external part of the catheter to make sure the catheter is where it's supposed to be or the PICC line is where it's supposed to be when they inserted it. So this is really helpful.

04:12 However, we're not going to use this today.

04:15 You also might see a little piece of tape as well in case you need additional securement.

04:20 So, that are all of the pieces of your central line dressing kit.

04:24 Now, let's jump into the procedure.

04:26 Now, before we get started, of course, we're going to perform our hand hygiene.

04:30 Check our to patient identifiers and provide privacy to the client.

04:33 This is a great time to explain the procedure to the client.

04:37 And don't forget to raise this bed to the appropriate working height for you.

04:41 It's also a great idea to make sure you help assist the patient in a proper position so you can get ease of access to the line when you're cleaning it and changing out the dressing.

04:51 Now, we can go ahead and put on the gloves.

04:54 Now, before we really get started, it's a great idea to go ahead and assess your client itself.

05:00 Now, if your patients experiencing any respiratory symptoms like shortness of breath or something like that, we need to consider this because it is ideal that we put that extra mask on our patient, and we have them turn their head away from the insertion site while we're doing our dressing change.

05:19 This is just going to keep our patient from maybe coughing or something like that on the insertion site itself.

05:25 Then we want to make sure we adjust the patient's gown so we can expose the patient, so we can get to the site and prep our equipment on our working space.

05:34 Now, before we even take off that old dressing, don't forget, because when we're looking at the dressing itself, this is a really good time to assess the current dressing.

05:45 Now, are there any signs of infection, any redness, any oozing, any swelling? We need to assess this and note this.

05:56 Now, let's take a look at our skills portion of the Central Line Dressing Change.

06:00 Now, I've went ahead and performed my hand hygiene.

06:02 And I'm going to go ahead and lower the bed rail of my patients so I'm not leaning over it.

06:07 This is the time we're going to check our to patient identifiers.

06:10 Provide privacy for our client.

06:12 And now we're going to go ahead and explain it to our client.

06:14 Now, it's really important here because you're at the patient's chest.

06:18 You want to raise this to appropriate working height.

06:21 So, it also helps to maintain sterility this way.

06:24 Now, when you're talking about doing the skill on the client, you really kind of want to position them in appropriate position.

06:32 So, I like to say about 45 degrees, I guess Semi-Fowler's.

06:35 This is a great time to go ahead and put on your gloves.

06:38 This is where we're going to put on our standard gloves.

06:41 Now, while I'm doing this, this is a great time to assess your patient.

06:45 If your patients having any respiratory symptoms, like if they're getting shortness of breath, we need to consider this if we're going to put a mask on the patient.

06:55 We really liked the patient to wear a mask because if they are coughing or anything like that, we don't want that to contaminate the line.

07:03 So, I ideally, I'm going to go ahead and put on my gloves.

07:06 If your patient can tolerate it, I want to go ahead and turn my patients head away from the side itself.

07:14 And at this point, we would want to go ahead and put the mask on the patient.

07:17 So, I'm going to put this on just right here.

07:20 So, now, this is a great time, we're going to go ahead and adjust our gown and our equipment just to make sure this is a good working height for us.

07:28 And during this time, before I take off this dressing, I want to assess a site.

07:33 I'm going to look at this look at the last time it was changed.

07:36 I also want to see if there's any infection, any redness, any swelling, any exudate that we need to look at this.