00:04
Now, this is a good time to go
ahead and prep our working surface.
00:07
So, I particularly like
the bedside table.
00:10
I like it a bit of an angle
because I want to be able
to maintain sterility
and be able to see a sterile field.
00:17
So, this is a good time to go ahead.
00:19
We've got our supplies, you're going
to kind of position this for me.
00:22
I'm going to go ahead now
and open my kit.
00:25
So, one thing I want to
note about opening your kit,
usually you've got
the little open piece.
00:30
You really don't want to open it
away from you.
00:33
If you guys remember
with sterility,
if you do that, you're kind
of leaning over the kit,
and we don't want to do that.
So why actually pull it towards me.
00:46
And I'm going to go ahead
and get rid of this flat
just so you guys can see.
00:50
And we're not having
to worry about that.
00:53
So, when you open up your kit,
the first thing we want to go ahead
and do is get that surgical mask.
00:59
So, like you see in this kit,
the surgical mask
is actually on top.
01:03
So, we're going to just
pinch in the middle.
01:06
And this is the time that we
would put this on ourselves
because this is important
while we're working.
01:12
We don't want to
cough on the client,
if we sneeze that's going to
contaminate our line.
01:16
Now, obviously for this segment,
since I've got to talk to you,
I'm not going to wear this and
I'm going to put this to the side.
01:23
So, now that I put
that to the side,
this is a good time because
we've got our old standard gloves,
we're going to go ahead and
remove the central line dressing.
01:31
So, when I do this,
a couple of things
you could get like an
alcohol prep pad is very nice
to go ahead and peel
up those corners.
01:40
This is going to help
loosen this up a little bit.
01:43
When you're removing this,
we've already assessed our site.
01:45
I want to go ahead and just
peel this up at the corners.
01:49
And notice that
I'm doing the corners
and I'm doing the corners because
I want to keep that site covered
as long as possible.
01:57
And I'm just gently
pulling these edges
kind of towards the middle and
towards the insertion site here.
02:10
And again,
sometimes it's very sticky
and you want to use like
an alcohol pad or something
like that to peel that off.
02:17
Okay, so now that we've done this.
02:19
This is kind of all
gathered in the middle.
02:22
I like to go ahead and kind
of hold my catheter aside,
just to make sure that
we don't dislodge anything.
02:29
So, I'm going
to go ahead and do this.
02:31
You see that there's
a little biopatch.
02:33
We're going to remove this as well.
02:36
And we're going to go ahead
and remove this dressing here.
02:44
Okay, so I'm going to take this.
02:46
I'm going to go ahead discard
my old dressing and my gloves
and throw this away.
02:50
And we want to re go ahead
and do our hand hygiene.
02:53
So, now, I'm going to go
ahead and get sterile.
02:55
So, I want to don
my sterile gloves.
02:57
So, when I do this,
again, just make sure
when you're working,
you're going to be able to keep
an eye on your sterile field.
03:04
I'm going to go ahead
and take my gloves,
I'm going to pinch in the middle.
03:09
Sometimes that's hard to do.
03:11
And then I'm going to move this
just so I don't contaminate it,
and I'm going to drop that here.
03:15
I'm going to go ahead and
don my sterile gloves.
03:20
And I always like
to fold these out,
because you see how
it likes to fold up,
and it kind of opens
up like a book.
03:29
And on a fullback, these corners
so they don't flop into itself.
03:34
When I'm trying to
don on my gloves.
03:36
Now, I'm going to pinch
just like a pizza,
slide them in. Going to keep this
so I don't drag this
all over my sterile field.
03:45
Don my gloves.
03:47
And you can see I kind of messed
up my fingers, but that's okay,
because we can fix them because
sterile sterile if you remember.
03:53
I'm going to go on my other cuff.
03:56
You know,
lift that try to keep that open,
keep my glove from
dragging my sterile field.
04:07
And then make sure I do that.
04:08
Now, if you do this,
which you might
now we can adjust it because it's
sterile to sterile on our gloves.
04:15
Let me just fix this.
I just so happened to do that.
04:19
So you can see how to fix
this today. Let's see.
04:23
Okay, now,
when I'm pulling, obviously
be conscious that you're not pulling
on that cuff that you touched.
04:30
And get that nice and down. Okay?
So, now that I'm sterile,
I can't touch anything else
besides sterile equipment,
I want to get rid of this.
04:38
So, I'm actually just going to keep
this and move this out of the way.
04:41
Now, this is the time I want
to actually grab my drape.
04:44
So I'm going to
pinch in the middle.
04:46
We've got our drape here
and I'm going to back away.
04:50
So, why don't drag this on my field.
I'm going to open this up.
04:54
And then you want
the shiny side down.
04:56
So a great way to do this
is to kind of fold your gloves
inside of it so it protects them.
05:03
And we're going to
lay down our drape.
05:05
Okay, and back away.
05:06
Now, that we've got this
working area,
now I can stick everything out,
which is much easier to work.
05:12
And just so I don't mess
anything up,
I'm going to actually
move this a bit.
05:16
I'm going to take out my Tegaderm
and lay everything out. Okay.
05:19
There's my Tegaderm.
Got my alcohol pad here.
05:25
I've got my tape if I need it.
We've got our tweezers.
05:30
And I think we're good there, okay.
05:33
So, now I'm going to go ahead
and I'm going to open up
my antiseptic swabs.
05:38
And actually, I'm going to go ahead
and move everything else out.
05:41
I don't need my gauze or my tape
today, so I'm going to get rid of those.
05:45
And I don't need my iodine swab
here, so I'm going to get rid of that.
05:49
So I'm going to go ahead and open these.
05:53
And my swab sticks,
instead of putting it on your field,
it's going to leak through.
05:58
This is what I was
talking about earlier,
I like to put this
in our sterile kit.
06:02
That way, if it leaks through,
it's in plastic, it's totally fine.
06:05
And we're going to
get rid of this, okay.
06:07
So, now, I'm going to go ahead
and take my first swab,
keeping an eye on my sterile field,
and we're going to clean
around the entry site.
06:14
This is where it's really nice
to actually also grab here,
grab your little tweezers
and grab your line.
06:21
So, it's very important that
when you start at this entry site.
06:25
We're going here, and we're
going in circles outside of it.
06:30
So, we're going to clean
that whole area.
06:32
So again, you start insertion,
and then you go out
in circles away from it.
06:37
Okay, so we're going to do that.
And then I can get rid of this one.
06:42
Then I'm going to grab another one,
and I want to go ahead
and clean my line as well.
06:47
So I'm going to clean my line and
we're going to go from the bottom
and we're going to go up
and work our way around it.
06:57
Okay, we get rid of this one.
06:59
And then I'm going
to take my last one
and we're going to work
all the way up our line.
07:04
So, know that you're going
all the way up your line
when you clean like this okay.
07:07
So, I'm going to go ahead
and get rid of this.
07:10
Now, if this is the time
if you had your biopatch,
you want to go ahead
and put your biopatch there.
07:15
So, you've just got to check your
facility policy with that. Okay.
07:19
Now, that we've done this, we can
actually lay this to the side.
07:25
Get rid of this.
07:26
And then I'm going to go ahead
and grab my transparent dressing.
07:30
And then I'm going to go
ahead and pull this apart.
07:35
And I'm going to
cover my site here.
07:38
So, when I cover my site, it's
really important that the window
is covering the insertion site.
07:44
We don't see,
we don't get the clamp.
07:46
We don't get the caps.
When we put this firmly down.
07:51
Okay, I can peel up these corners.
08:06
I want to make sure
all four corners are down.
08:09
Those are nice and adhered.
08:13
Okay, and that's now covered.
08:15
Now, the other thing before you get
rid of your dressing, don't forget,
you have this little label here.
08:21
That's got, when you have
to take credit for your work
of when the date and
the initials are.
08:26
So, you want to make sure you
keep an eye on this, okay?
Now, sometimes there's
going to be a time
where even more of a surface area,
this is a good time to put a second
dressing down if you need it.
08:36
But again, as you notice,
we kept from covering up
the clamp or the line itself.
08:41
So, you just want to make
sure you keep an eye on that.
08:44
Now, that we've
applied our dressing,
we're going to go ahead
and change our caps.
08:47
So, one thing to know is
now that this whole
insertion side is covered,
we're really kind of good here,
we're really kind of switched
into aseptic technique, okay.
08:57
So when we're talking
about changing caps,
this is really the opportune time is
after you've done
a central line dressing change,
most agency guidelines, say go
ahead and change out those caps.
09:07
And sometimes we will do a
central line dressing change
and draw blood at this point.
09:12
And you definitely
want to make sure
you put a clean cap on afterwards.
09:16
All right, so let's go
ahead and open up our cap.
09:19
So, I'm going to take this,
I'm going to open them.
09:21
I'm going to leave it
in my package here.
09:25
Now, I'm going to go ahead and
grab with my hand, my old cap,
and I'm going to go ahead
and remove this one.
09:31
And we're going to get rid of this.
09:32
And again, don't forget to
make sure your line is clamped.
09:35
I'm going to take my new one,
it's very important
to make sure you don't touch
the end of that.
09:40
There's a little clear cap
on here to keep that clean.
09:43
You want to make sure
this comes off.
09:47
We're going to remove this
without touching the end
and that's very important.
09:52
Okay, so we're going to
get rid of this.
09:54
You'll see I have that
and I'm not touching the end,
and then I'm going to go into end.
10:00
And I'm going to go ahead
and fix that there, okay.
10:02
So, once that's on there,
and we've attached the new cap,
if there's several lines,
you want to go ahead and
repeat the same procedure.
10:10
And then now we can go ahead
and open up the lock device
or the clamp by your agency policy.
10:16
Now, we can dispose of all of
our equipment as appropriate,
We can make sure we apply
any dressing change.
10:23
Now, we talked about
like per policy.
10:26
So, we want to go ahead date
initial and this put this on here.
10:29
So, I'm actually going
to go ahead and do that.
10:30
But of course, I would put
my initials, date and time.
10:33
And you want to make sure,
do not cover your insertion site.
10:37
So, just put this to the side
where you can see it.
10:39
We want to go ahead and cover our
client backup provide privacy,
lower the client's bed
to the lowest position,
make sure we put up the side rails,
we're going to remove our gloves
perform our hand hygiene,
and make sure the call bell is
with our patient before we leave.
10:53
And of course, we want to make
sure we document our procedure.
11:00
Now, we can go ahead and dispose
all of our equipment appropriately.
11:04
Make sure you lower that client's
bed to the lowest position
and make sure their
call light is within reach.
11:10
We can remove our gloves,
perform our hand hygiene,
and ensure that we
document the procedure.
11:15
So, now that we've done
the central line dressing change,
let's look at a sample of what
documentation should look like
in our patient record.
11:23
So, the central line catheter site
was assessed during
the schedule changed.
11:28
Now, 2 mm of redness was noted
around the insertion site
without exudate or odor.
11:34
The central line dressing
on the right chest wall
was changed per guidelines.
11:38
One quick thing I want to note
about this documentation is that
there's objective measurable data.
11:44
This is always ideal when you're
documenting any procedure.
11:48
Let's take a look at some
special considerations
when we're talking about
central line dressing changes.
11:54
Always make sure
that you're assessing
for signs and symptoms
of inflammation.
11:59
You could see exudate,
odor, redness,
even maybe a low grade fever
in your patient.
12:04
You want to take a look at this.
12:06
Any signs of phlebitis so redness,
swelling, pain around the site
and of course
central line infection.
12:12
This could look a lot
of different ways.
12:14
It could look like a fever,
elevated white blood cells,
redness, puffiness,
drainage around the site.
12:20
You want to assess this as a nurse.
12:22
Also, a lot of the times when
you are changing out a dressing,
you may decide to do a blood draw.
12:28
You may flush after
and you might notice
that that line is occluded.
12:32
If this is the case, you want
to stop and notify the provider.
12:37
A couple more
considerations is that
the central line dressings,
any of them that are wet, soiled,
maybe the corners are pealed up
if it's not adhered, well,
we've got to replace this.
12:47
This is opening up
to a source of infection.
12:50
So you want to change that central
line dressing at regular intervals
per your facility protocol.
12:56
Now, the central line
should be flush regularly
despite fluid running.
13:01
Now, I know we may have
normal saline running in the line.
13:04
However, diligent flushing
is also important
to prevent line occlusion.
13:10
Now, when the central
line dressing is changed,
the procedure should
be dated and documented
typically both on the dressing
itself and the patient record.
13:20
And generally, agency's policies
may indicate the change
the dressing now,
we talked about the gauze
but if there is gauze under there,
or there's an indication for it,
we have to change this
out much more often.
13:32
So about every two days or so.
13:34
Now, if we do not have gauze
and it's just a clear
transparent dressing,
this is about every
five to seven days.
13:41
We always want to assess the
need for the central line itself.
13:45
Any early removal of any line
is always best practice
to reduce infection
and verify the accuracy
of the clients labels
and apply the labels
to the clients bedside.
13:57
Thanks for watching today.