On the CUSP: STOP BSI
Central Line Dressing Change
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Terminology for Lines Included
• Percutaneously placed central lines
• Tunneled lines
• Peripherally inserted central catheter
• Vascular Access devices
* May not include hemodialysis catheters.
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Who Completes
• Nursing Personnel who have demonstrated
competency for central line dressing changes,
including PICC teams and Nurse practitioners.
• Medical personnel who have demonstrated
competency including physicians and physician
assistants.
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Frequency
• Once weekly if a transparent dressing is used
• Every day if a gauze dressing is used while bleeding
• Any time a dressing is no longer occlusive, damp or
visibly soiled.
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Equipment Needed
• Chlorhexidine Gluconate 2%
w/ Isopropyl Alcohol 70%
(1 Swab)*
• Transparent dressing or gauze
– * do not use if patient is sensitive
Tincture of iodine or 70% isopropyl alcohol
may be used.
– *do not use chlorhexidine in patients
<2 years old.
• Sterile Gloves
• Mask for person applying
dressing
• Cone mask for patient
• Skin prep
(appropriate size)
• Tape if gauze dressing is used
• Clean Gloves
(appropriate size)
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Additional Supplies that
May Be Needed
• Sterile cotton tipped applicator
(needed to cleanse insertion site)
• Sterile cup to hold sterile saline
• Sterile normal saline
• Adhesive removal pads or alcohol wipes
• Sterile 2x2 gauze
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Procedure: Preparation
1.
Explain procedure to patient/family.
2.
Wash your hands.
3.
Don clean gloves and remove old dressing using alcohol swab
or adhesive remover pads as needed.
4.
Inspect insertion site of catheter for signs of infection. Culture if
needed. Assess security of sutures.
5.
Remove your gloves.
6.
Open sterile gloves and create a sterile field using sterile glove
package.
Continued…
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Procedure: Sterilization
7.
Open Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70%
swab and drop onto sterile field.
8.
Open transparent dressing and drop onto sterile field.
9.
Open skin prep and place on outer edge of sterile field.
10.
Don sterile gloves.
Continued…
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Procedure: Cleansing the Site
11.
Clean skin with Chlorhexidine Gluconate 2% with Isopropyl
Alcohol 70% swab.
12.
Using friction or scrubbing motion to apply. Begin directly at the
insertion site as you move swab outward in a circular motion to
cover all areas without retracing the area already cleansed.
13.
Allow Chlorhexidine Gluconate 2% with Isopropyl Alcohol 70%
swab to air dry completely.*
*If using povidone iodine, allow to remain on the skin for at least 2
minutes, or longer until dry.
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Preparing to Place Dressing
14.
Designate one hand to be the unsterile hand and pick up
the skin prep packet.
15.
Remove skin prep pad with sterile hand.
16.
Apply skin prep on outer perimeter of skin where dressing
edge will touch patient.
*Do not put skin prep over the catheter insertion site or the
immediate surrounding area. Allow to completely dry.
*Do not apply organic solvents (e.g., acetone or ether) to the skin
before insertion of catheters or during dressing changes.
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Placing the Dressing
17.
Using your sterile hand, apply transparent dressing per
manufacturer recommendations.
18.
Label the dressing with date, time and initials to identify
when changed.
19.
Document the dressing change on the flow sheet per protocol
if indicated.
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Other Options
• Please see other infection prevention options under the
infectious disease series for information on Chlorhexidine
impregnated patches, antibiotic coated catheters etc.
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References
• Johns Hopkins Hospital, Vascular Access Device
Policy (Adult)
http://safercare.s3.amazonaws.com/support_medi
a/docs/clabsi/Appendix_H_Adult_VAD_Policy.pdf
• MMWR Guidelines for the Prevention of
Intravascular Catheter-Related Infections
http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf
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On the CUSP: STOP BSI Central
Line Maintenance
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Learning Objectives
• Review the evidence and recommendations for
central line maintenance
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Source of Recommendations
• Centers for Disease Control
• Society for Healthcare Epidemiology of America
• Infectious Diseases Society of America
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Overview of Recommendations
Central line maintenance recommendations address
the following topics:
•
•
•
•
•
•
•
Central line insertion
Central line dressing changes
Replacement of IV administration sets
Hang time for parenteral fluids
Catheter hub cleansing
Removal of unnecessary lines
Education
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Central Line Insertion
• Ensure use of checklist
• Empower nurses to stop the procedure if the steps in
the checklist are not followed
• Leadership must create a culture that supports
nurses
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Central Line Dressing Change
Dressing change responsibility includes only those who
have demonstrated competency:
• Nursing personnel including PICC teams and nurse
practitioners
• Medical personnel including physicians and
physician assistants
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Central Line Dressing Change
Frequency:
• Transparent dressing
– Every 7 days
– PRN if damp, loosened, or soiled
• Gauze dressing
– Every 48 hours for routine use
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Replacement of IV Administration Sets
• Lipids and blood products (enhance bacterial
growth)
– Change every 24 hours
• All other IV administration sets
– No more frequently than every 72 hours
– Not more than every 96 hours
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Hang Time for Parenteral Fluids
• Lipid-containing parenteral nutrition
– Change every 24 hours
• All other IV fluids including nonlipid-containing
parenteral nutrition
– No formal recommendations
– JHH changes nonlipid-containing IV fluids every 24 hours
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Catheter Hub Cleansing
• Clean hub before accessing with Chlorhexidine or
70% alcohol
• No formal recommendations regarding how long to
cleanse hub
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Remove Unnecessary Lines
• Assess need for continued central line access
during daily multidisciplinary rounds
– Add question to a Daily Goals worksheet
– Complete every day during rounds
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Education
Educate all necessary staff:
• Guidelines to prevent catheter-related bloodstream
infections
• Use of central line checklist
• Proper insertion and maintenance of central lines
Ensure competency through yearly education and
examination
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References
•
Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central
line-associated bloodstream infections in acute care hospitals.
Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22S30.
•
O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the
prevention of intravascular catheter-related infections. Infection
Control and Hospital Epidemiology. 2002; 23(12):759-769.
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