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PROCEDURE FOR DRESSING
CHANGE FOR CENTRAL LINES AND PERIPHERAL ARTERIAL LINES
Equipment Required:
1. 1 sterile green towel
2. 2- Chorhexidine 2% and 70% alcohol swabs
3. Suitable dressing (eg.Tegaderm, gauze and tape)
4. Steri-strips if required
5. Non-sterile gloves
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Procedure |
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Rationale |
| 1. |
- Explain procedure to patient.
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1. |
- To reduce anxiety and enhance cooperation.
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| 2. |
- Change dressing q 7 days (transparent) and prn for arterial/central line dressing. If using tape and gauze on central/arterial lines dressing should be changed q 48hrs.
- For peripheral line dressing q 7days and prn in addition to flolink change at the same time.
- Change any dressing that has loosened or lost its occlusive properties.
- Observe for redness or signs of infection and report to physician if noted.
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2. |
- Due to poor skin integrity, diaphoresis etc, dressing changes are done q48hr and prn to remove skin colonization. If the patient is stable with good skin condition, Tegaderm dressings may be left in place for 7 days (per hospital policy).
- There is no evidence that routine line change dates decrease infection rates; insertion of a new line poses a risk for introducing infection. Lines are changed when evidence of redness or infection is present.
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| 3. |
- Don non-sterile gloves and remove old dressing. Perform hand hygiene.
- Open sterile towel to create a field.
- Open and drop 2 chlorhexidine swabsticks onto green towel.
With first swab, scrub from top to bottom in a vertical pattern.
- With second swab, repeat scrubbing from side to side in a horizontal pattern.
- Allow chlorhexidine to dry.
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3. |
- Chlorhexidine is an effective antimicrobial agent; it appears to have prolonged activity on gram positive organisms.
- There is no evidence that cleansing in a circumferencial manner around the site is effective.
- There is evidence that skin microbial counts can be lowered by this scrubbing technique.
- The scrubbing motion allows the antiseptic to penetrate skin layers.
- Antimicrobial antivity persists following drying.
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| 4. |
- Apply an occlusive dressing.
- Using Tegaderm is the preferred dressing per LHSC central line procedure.
- Pressure dressings are not indicated.
- Avoid circumferential dressings.
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4. |
- Dressing must remain occlusive to prevent bacterial contamination.
- There is little difference in benefit between gauze or polyurethane dressings related to infection control for peripheral lines.
- Polyurethane allows for visualization of the wound, whereas, gauze may is cheaper and may provide better adherence in patients with a coagulopathy; wound colonization with gauze increase >48 hours.
- An arterial line site should not bleed. Bleeding can be very profuse with exanguination potential; a light dressing allows for prompt detection. A pressure dressing would be inadequate to stop an arterial bleed.
- Circumferential dressings could create a tourniquet effect and decrease circulation.
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| 5. |
- Place a small gauze under the stopcock and tape away from insertion site dressing.
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5. |
- To pad stopcock and protect skin.
- To prevent soilage of aseptic dressing during blood withdrawal.
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| 6. |
- Document in clinical record and describe site.
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6. |
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| 7. |
- Update Kardex with date next change is due.
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7. |
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| 8. |
- Report any site problems/drainage to physician.
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8. |
- Medical intervention may be required.
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References
Centre
for Disease Control Guidelines for Prevention of Intravascular Catheter-Related
Infections. http://www.cd.gov/mmwr/mmwr_rr.htm (August 9, 2002/vol.51/No.RR-10).
Hibbard,
J., Mulberry, G., Brady, A. (2002). A clinical study comparing the skin antisepsis
and safety of ChloralPrep, 70% Isopropyl Alcohol, and 2% Aqueous Chlorhexidine.
Journal of Infusion Nursing. 25(4), 244-249.
Safer Health Care Now (2006). Safer Health Care Now Getting Started Kit: Prevent Central Line Infections, How to Guide. Taken from www.saferhealthcarenow.ca
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