NAME ________________________________ POSITION _________ UNIT ________

EVALUATOR__________________________ POSITION __________DATE________


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


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.

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:

- place folded 2x2 over insertion site to include sutures to prevent the tape/ elastoplast from sticking to the line and sutures.

- paint around the edges of the gauze with skin prep and allow to dry.

- cut elastoplast to fit over insertion site and sutures.

- apply elastoplast and secure edges with tape.

b. Occlusive Dressing- (Tegaderm):

- do not use 2x2

- skin prep is optional

- apply occlusive dressing according to manufacturer’s guidelines.

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 2x2 gauze used after initial insertion under occlusive (Tegaderm) dressing, dressing must be changed in 24 hours.    

*** Must perform these critical elements for successful completion.

REFERENCE: Infection Control Manual

February 04, 2009

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