| Critical
Performance Elements |
yes |
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| 1. Gather all
necessary equipment: roll of tape, label, and
central line line dressing kit. |
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| 2. Wash hands.
Explain procedure to the patient and/or significant
others. Check for providone-iodine or tape
allergy.
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| 3. Organize
supplies and equipment at bedside to decrease the
amount of time
that site is open to air.
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| 4. *** Open
central line kit. Don mask. (Don gown if soiling
is likely).
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| 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.
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| 6. *** Don a
pair of clean gloves. |
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| 7. Remove
present dressing carefully to minimize trauma and
prevent accidental dislodgment of catheter.
Discard soiled dressing in proper trash
receptacle. |
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| 8. Visually
inspect the skin and catheter site for signs of
infection, leakage, or other mechanical problems. |
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| 9. *** Remove
soiled gloves and don sterile gloves. |
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| 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.
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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.
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| 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.
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| 13. *** Loop and
secure IV tubing to dressing and arm or chest.
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| 14. *** Label
dressing with time, date of dressing change and
insertion, and initials. |
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| 15. Discard
supplies used. Wash hands. |
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| 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. |
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| NOTE: If 2x2
gauze used after initial insertion under
occlusive (Tegaderm) dressing, dressing must be
changed in 24 hours. |
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