Central Line Dressing Change: Procedure Skills and Post-procedure (Nursing)

by Samantha Rhea, MSN, RN

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    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.

    About the Lecture

    The lecture Central Line Dressing Change: Procedure Skills and Post-procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Central Line Care (Nursing).

    Included Quiz Questions

    1. Using an alcohol prep pad to help lift the edges of the dressing
    2. Working at the edges of the dressing first so that the insertion site remains covered as long as possible
    3. Soaking the dressing with a damp cloth before removal to ensure it comes off in one piece
    4. Refraining from touching the catheter at any time to maintain sterility
    5. Pinching the dressing in the middle and pulling upwards so that the edges all pull up together
    1. Laying out the materials needed for the dressing change from the dressing kit on the sterile drape
    2. Cleaning the insertion site
    3. Applying the transparent dressing over the insertion site
    4. Removing the old biopatch from the insertion site
    5. Opening the central line dressing kit
    1. The frequency of changing the cap depends on agency policy
    2. The central line catheter needs to be clamped when the cap is changed
    3. It is a sterile procedure
    4. It is only done after blood is taken from the central line
    5. The end of the cap should be cleaned with an alcohol swab for 90 seconds while wearing clean gloves
    1. A two-inch border of redness around the insertion site
    2. Swelling around the insertion site
    3. The central line catheter is protruding three inches further from the insertion site than it was yesterday
    4. The central line is unclamped
    5. The skin around the insertion site is warm and dry
    1. At a regular frequency determined by agency policy
    2. If the dressing is soiled
    3. If the dressing edges are no longer adhered to the skin
    4. After each time the central line catheter is flushed
    5. After each time blood is drawn from the catheter

    Author of lecture Central Line Dressing Change: Procedure Skills and Post-procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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