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17.1 Central venous catheter: insertion site dressing change

This procedure can be adapted for changing a peripheral cannula dressing, although such dressings are rarely changed and are usually removed along with the cannula.

Essential equipment

  • Personal protective equipment
  • Sterile dressing pack (containing sterile towel, low‐linting gauze and gloves)
  • Alcohol‐based skin‐cleaning preparation, 2% chlorhexidine in 70% alcohol
  • Semi‐permeable transparent dressing (IV film dressing), sterile low‐linting gauze or another appropriate dressing
  • Hypoallergenic tape

Optional equipment

  • Securing device
  • Bacteriological swab

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [356], C).

Procedure

  1. 2.
    This procedure should be performed using an aseptic non‐touch technique.
    To prevent infection (DH [117], C). (For further information on asepsis, see Chapter c04: Infection prevention and control.)
  2. 3.
    Screen the bed. Assist the patient into a supine position, if possible.
    To allow dust and airborne organisms to settle before the insertion site and the sterile field are exposed. E
  3. 4.
    Wash hands with soap and water, or an alcohol‐based handrub, and dry.
    To reduce the risk of cross‐infection (DH [117], C; Fraise and Bradley [156], E).
  4. 5.
    Place all equipment required for the dressing on the bottom shelf of a clean dressing trolley.
    To reduce the risk of cross‐infection (DH [117], C).
  5. 6.
    Take the trolley to the patient's bedside, disturbing the screens as little as possible.
    To minimize airborne contamination (DH [117], C).
  6. 7.
    Open the sterile dressing pack onto the top of the trolley.
    To gain access to the equipment. E
  7. 8.
    Attach an orange clinical waste bag to the side of the trolley below the level of the top shelf.
    So that contaminated material is below the level of the sterile field (DH [117], C).
  8. 9.
    Open the other sterile packs, tipping their contents gently onto the centre of the sterile field. Pour lotions into gallipots or into an indented plastic tray where required.
    To reduce the risk of contamination of contents. E
  9. 10.
    Wash hands with soap and water, or an alcohol‐based handrub, and dry.
    Hands may have become contaminated by handling the outer packs (DH [117], C).
  10. 11.
    Place the sterile field under the patient's arm or on their chest.
    To create a clean working area. E
  11. 12.
    Loosen the old dressing gently.
    So that the dressing can be lifted off easily. E
  12. 13.
    Put on clean gloves.
    For protection from any contact with the patient's blood. E
  13. 14.
    Using gloved hands, remove the old dressing and discard it. Remove tapes or the securing device if loose, contaminated or due to be changed.
    To remove the old dressing without contaminating hands (DH [117], C).
  14. 15.
    If the site is red or discharging, take a swab for bacteriological investigation.
    For identification of pathogens. To select appropriate treatment (DH [117], C).
  15. 16.
    Remove and dispose of gloves, clean hands with an alcohol‐based handrub and put on sterile gloves from pack.
    To minimize the risk of introducing infection (DH [117], C).
  16. 17.
    Clean the wound with 2% chlorhexidine in 70% alcohol, using back‐and‐forth strokes with friction. Allow the area to dry prior to applying the dressing.
    To enable the disinfection process to be completed. To prevent skin reaction in response to the application of a transparent dressing to moist skin (Loveday et al. [278], C; NICE [351], C).
  17. 18.
    Reapply tapes or the securing device if necessary. This may require skin preparation prior to application of the securing device.
    To secure the device and prevent dislodgement and phlebitis (Rickard et al. [383], E; Schears [402], R).
  18. 19.
    Apply the appropriate dressing, moulding it into place so that there are no folds or creases.
    To minimize skin irritation and reduce the risk of the dressing peeling or becoming damaged. E
    To ensure security of the device and prevent dislodgement. E
  19. 20.
    Document the date and time on the dressing.
    To ensure the dressing is changed as required (DH [117], C; Gorski et al. [181] C; NICE [351], C; RCN [381], C).

Post‐procedure

  1. 21.
    Remove gloves and dispose of in waste bag.
    To dispose of waste. E
  2. 22.
    Fold up the sterile field, place it in the orange clinical waste bag and seal the bag before moving the trolley. Draw back the curtains. Dispose of waste in the appropriate containers.
    To prevent environmental contamination (DH [117], C).
  3. 23.
    Document the date and time of the dressing change, site observations and any relevant changes at the insertion site in the patient's records.
    To ensure adequate records are maintained and to enable continued care of the patient and device (NMC [356], C).
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