Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [159], C).
2. 2.Show
   Wash hands with soap and water. Clean the trolley or other appropriate surface according to local policy.
   To minimize cross‐infection (Preston [177], C).

   To provide a clean working surface (Parker [167], E).
3. 3.Show
   Position the patient comfortably on their side or sitting forward so that the site is easily accessible without undue exposure of the patient.
   To maintain the patient's dignity and comfort. This is especially important when carers are attending to an area that is not visible to the patient (Chapman and Day [36], E).
4. 4.Show
   Prepare trolley or tray with sterile field and cleaning solution.
   To minimize risk of infection and ensure equipment is available (Preston [177], C).

Procedure

1. 5.Show
   Remove old dressing and place in disposable bag.
   To prevent cross‐infection (Loveday et al. [125], E).
2. 6.Show
   Wash hands with bactericidal handrub. Put on gloves and personal protective apron.
   To minimize the risk of microbial contamination (Fraise and Bradley [78], E).
3. 7.Show
   Observe site for any signs of infection such as redness, swelling or purulent discharge. If any of these are present contact the hospital anaesthetic/pain team for advice.
   To ensure careful monitoring of site to minimize the chance of any infection (Royal College of Anaesthetists [196], C).
4. 8.Show
   Clean site with skin‐cleaning agent (chlorhexidine in 70% alcohol).
   To minimize the risk of infection (Hebl [93], R5; Kinirons et al. [117], R1b; Mimoz et al. [147], R1b).
5. 9.Show
   Apply transparent occlusive dressing over the whole area.
   To anchor the epidural/intrathecal catheter, minimize the risk of infection and allow observation of the epidural/intrathecal site (Burns et al. [30], R1b; Royse et al. [197], E).
6. 10.Show
   Ensure that the patient is comfortable.
    

Post‐procedure

1. 11.Show
   Remove gloves and apron and dispose of all material in the clinical waste bag.
   To prevent environmental contamination (Preston [177], C).
2. 12.Show
   Wash hands with soap and water.
   To reduce the risk of cross‐infection (Preston [177], C).