Central Line Dressing Change: Procedure Steps (Nursing)

00:04 Now, for the procedure itself, we want to make sure we prepare our working area and open up the central line dressing kit.

00:11 This is a great time to do this on our working table.

00:14 And you want to choose a hard flat surface so you had spread out all your supplies like you see here.

00:19 Now, we want to open the kit. And when you do try to remember when you open it to open it towards you so you're not reaching over your sterile field.

00:29 This is the time that in which once you open your sterile kit, there's going to be the mask that is inside on top.

00:36 This is the time when you want to take this and put this on yourself.

00:41 Now, after we do that, we want to go ahead and apply our surgical mask.

00:46 Then we want to while wearing our old gloves, we want to go ahead and come back to the patient.

00:52 And we want to pull the sides up of each part of the dressing and make sure we're pulling in the direction of the insertion site.

01:00 This is going to be important that we don't pull it this way so we don't migrate or pull the catheter.

01:05 Now, as you know this is sometimes very sticky, so you may want to go ahead and use like the adhesive alcohol pad or something like that to prevent that skin damage from pulling up the adhesive.

01:19 Now, once we take off the old dressing, and we've pulled off those edges, carefully peel those off.

01:25 And while doing this, it's a good idea to hold the end of the catheter in place so it doesn't move.

01:30 We can now discard the old dressing and the gloves.

01:34 And again, good time to check the catheter site for signs of infection such as redness, swelling, drainage or even a foul odor.

01:43 We want to discard that old dressing per agency policy.

01:47 Okay, so now we can get sterile.

01:49 We're going to remove that sterile drape that was in the kit.

01:53 Don't forget to back away from your table so you don't drag that all over and mess up your sterile field.

01:59 And don't forget the shiny side of that.

02:01 We want to point that away from us and lay it on our working area because this is where our supplies are going to be.

02:08 Now, once we've laid those supplies out on that drape, this is going to be covering our full working area.

02:14 Now, we can start with our antiseptic prep swabs or those alcohol swabs, and we can lay these three into the sterile kit packaging.

02:22 This is always nice because since there's moisture, if you put it on the drape itself, sometimes it leaks through.

02:28 So, it's great to put it in the plastic packaging, and it's still sterile.

02:32 Now, we want to take that first swab or the alcohol swab or the ChloraPrep to clean around the entry site itself.

02:40 Now, this is really important that we clean in circle starting at the entry site and go outward.

02:46 So if the entry sites here go outwards away from that, so we're not bringing bacteria in the actual site itself.

02:53 We want to go from site and moving out.

02:56 Now, we're going to repeat this with the remaining swabs, or the prep pads, or your ChloraPrep.

03:01 Now, you want to also clean the central line itself, We forget about that. We've cleaned the site.

03:07 Now, don't forget to clean the catheter beginning at the entry point and up away from the patient.

03:13 Good time now to apply our biopatch to the entry site.

03:17 And then we can lay that transparent dressing over that insertion site and gently press down that and make sure that's adhered.

03:24 Now, once we've done that, we want to make sure all four corners are down, everything's adheres nicely.

03:30 And we want to remove that paper border to adhere the full dressing site to your patient.

03:36 Now, sometimes, there's a little bit of a like a removable tag there, that's really important that we take credit for our work, we put that on the transparent dressing so we can date and time that so the next nurse knows when that was done.

03:50 Now, some kits include a second transparent dressing.

03:53 This is usually desired if there's a greater surface area to be covered.

03:58 Avoid placing that dressing over any of the caps or any of the clamps on the line itself.

04:04 Now, your cap change policy varies by each institution.

04:08 Typical guidelines, you're going to see that you're going to change those caps with every dressing change.

04:13 Especially anytime that you draw blood out of the line, it's a great idea to go ahead and change out those caps.

04:20 Now, most caps are impregnated with an antiseptic property to help reduce infection as well.

04:27 And changing the caps are done using aseptic technique.

04:31 Make sure you remember that piece.

04:33 Now, we want to open up the cap package and leave the cap inside the package itself to maintain sterility.

04:40 Now, while wearing gloves, we can ensure the existing line lock device is clamped shut, this is very important.

04:48 We want to go ahead remove that old cap.

04:50 And now the new cap usually has a little bit a clear cover over the end of it that attaches to it.

04:57 We want to go ahead and remove that cover and attach the new cap to the end of the line maintaining aseptic technique.

05:04 Now, if there's several lines, we need to repeat this step.

05:07 Now, we can open up the lock device on each of the line for policy.