Equipment:
* Mask
* Alcohol or Sani-Cloth™ – to clean work surface
* 1 pair non-sterile gloves
* CVC dressing tray (CHG included)
* 1 pair sterile gloves (included)
* Appropriate size transparent dressing (small included)
* Sterile normal saline or alcohol swab (optional)
* For securing the CVC, use tape, clamp, Coflex™, or X-Span™ dressing, or
appropriate securement device as indicated.
POLICY:
1. Dressings on a newly inserted tunneled and non-tunneled CVC MUST BE changed within
the first 24-48 hours of placement. Picture link: Tunneled & Non-Tunneled Dressing.
2. Tunneled CVC dressings are to be changed ONCE a week.
Exception: Tunneled CVC dressings on immunosuppressed patients
are to be changed TWO times per week.
3. Non-tunneled CVC dressings are to be changed TWO times a week.
4. All CVC dressings that are NOT clean, dry or occlusive MUST BE changed, not
reinforced.
5. CVC site MUST BE cleansed with a 30 second CHG scrub followed by a 30
second air dry. The ChloraPrep™ Sepp Applicator (.67 mL) may be used for site care of a small infant in place of the ChloraPrep™ One-Step Applicator (3 mL).
1. The CVC site assessment MUST BE documented hourly and following dressing change.
2. CVC site assessment includes inspection of skin surrounding catheter site and
documentation of:
– Intact sutures
– Skin integrity
– Redness, drainage, induration
– Visible or palpable cuff
– Occlusiveness of dressing
3. A transparent adhesive dressing is the standard dressing covering (e.g. Tegaderm™,
Opsite 3000™).
Exception: Skin breakdown or irritation may require an alternative to
the standard dressing and frequency of dressing changes.
Contact CVC Resource for recommendations.
4. If any redness, induration or drainage is noted at the exit site a culture may be indicated.
SAFETY GUIDELINES:
1. Any CVC MUST BE secured with appropriate securement device based on patient
developmental and activity level to prevent drag or tension on catheter at exit site.
Examples for securing a CVC:
a. Secure hub with securement device.
b. Secure tape flap on CVC hub with clamp to undergarment or to tape flap
secured to infant's body or X-span™.
c. Cut X-span™ tubular dressing into a vest to fit child and to hold catheter.
d. Clamp tape flap of catheter to clothing only on older school age or adolescent
child.
2. DO NOT use scissors to remove tape or dressings.
1. Mask all participants.
2. Perform HAND HYGIENE.
3. Clean work surface.
4. Using wrapper as a sterile barrier, open Dressing Tray Kit.
5. Apply non-sterile gloves.
6. Remove old dressing. DO NOT touch skin under the dressing. Dispose of old dressing.
7. Remove gloves and put on sterile gloves.
8. If drainage present, remove with sterile 4X4 and normal saline or alcohol swab.
9. Activate CHG applicator.
10. Cleanse the site using a back and forth scrubbing motion that follows a circular pattern around the exit site for 30 SECONDS.
11. Allow CHG to air dry at least 30 SECONDS. DO NOT BLOT DRY.
12. Cover site with transparent dressing.
13. Slit small piece of tape in the center and slide under catheter to secure transparent dressing to skin.
14. Slide a longer length of tape (sticky side up) under the catheter and chevron it over the tegaderm.
15. Secure anchor piece of tape over previous tape strips.
16. Date and initial dressing.
17. Secure CVC.
18. Document procedure and assessment
