Dressing change

Review your facility policies and procedures.

Strict adherence to aseptic technique is necessary to reduce catheter related blood stream infection (CRBSI). While aseptic technique is a constant, dressing change policy & procedure (P&P) may vary among institutions. Your institution's P&P is the best guide to safe patient care.

Standard precautions are usually sufficient for uncomplicated catheter dressing change procedures. Mask, eye protection, skin protection are minimum requirements.

Many institutions will provide a pre-packaged sterile dressing change kit.
Sterile kits will likely include:

• Properties of CHG

  Rapid activity against gram pos & neg Bacteriocidal and bacteriostatic against skin organisms (48 hr.) Active in presence of blood & serum 50% fewer CRBSIs vs. povidone Low concentrations distrupt bacterial membrane, high concentrations cause congealing of bacterial cytoplasm

  Mask
• Latex-free exam gloves
• Drape
• Measuring tape
• Alcohol pads or swabs
• >0.5% Chlorhexidine gluconate (CHG) with 70% alcohol skin prep or povidone skin prep.
• Chlorhexidine-impregnated catheter dressing
• Skin adhesive prep and adhesive strips
• Transparent dressing
• Needleless connectors
• Various sponges
• Dressing change label

Dressing Change Scenario

• Verify dressing change order (patient, site, time)
• Wash hands it's one of the most important factors in reducing catheter related infections. (CDC, 2002).
• Gather nonsterile supplies:
  • Secure a clean and dry work area
  • Personal Protective Equipment (PPE), e.g. cap, eye protection, cover gown, non-sterile gloves as needed?
  • Alcohol pads
• Gather prefilled normal saline flush syringes and prefilled 10u heparin flush syringes (1 each for every port)
• Gather sterile supplies (examine packaging for defects)
• Sterile dressing change kit
• Antimicrobial catheter dressing if not included in kit
• Catheter stabilizing device
• Sterile needleless connector (one per port)
• ID patient
• Elicit patient concerns about the catheter
• Explain the procedure to the patient:
  • Importance of maintaining sterile field
  • Importance of avoiding respiratory contamination or use mask if patient can't face away
  • Placement of drapes
  • Expected sensations: tugging of old dressing, cold cleansing solutions, etc
• Wash hands
• Don PPE (consider a cap to control hair for you and the patient as needed)
• Don non-sterile gloves
• Position patient for site access with patient facing away from insertion site
• Assess site and arm, chest and neck for exudate, erythema, ecchymosis, palpable cord or tape burns, swelling, pain, warmth and for collateral circulation.
• Dispose of gloves, wash hands
• Open sterile dressing change kit using aseptic technique
• Retrieve and don mask
• Open chlorhexidine-impregnated sponge dressing into sterile dressing kit
• Open catheter stabilizing devices into sterile dressing kit
• Don non-sterile gloves
• Carefully loosen the old dressing by lifting the edges of the transparent dressing with an alcohol pad. Carefully lift, stretch to remove and discard the old dressing without contaminating the insertion site or dislodging the catheter. Remove the biopatch with the dressing.
• Visually inspect site for signs of: inflammation, infection, tenderness, bleeding etc.
• Use alcohol pads to remove any catheter stabilizing devices including tape.
• Dispose of non-sterile gloves, handwash and don sterile gloves using aseptic technique.
• SKIN Prep:
  • Remove any visible debris with alcohol swabs.
  • Use CHG applicator per manufacturer instruction. Completely wet the treatment area with antiseptic. Scrub with a back and forth motion, cleanse the insertion site, catheter and >2" radius from the site for 30 second
  • Do not blot, allow to dry for 30 seconds
• Apply antimicrobial dressing, align slit in the direction of the catheter.
• Apply sterile skin prep adhesive to area intended for the stabilizing device and allow 30 seconds to dry
• Secure catheter to the stabilizing device and apply to the prepared skin
• Apply the new sterile transparent dressing, placing the insertion site in the center of the dressing.
• Measure external catheter length and arm circumference 10cm above and below the antecubital fossa. Apply label to dressing that identifies the date of dressing change, type & external length of catheter and arm circumference.

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