Now let's discuss the
CVC dressing change. Usually, the dressing change needs to be done
once or twice a week depending on the type of dressing that you will
use. You should also change the dressing as soon as possible if it
is wet either from perspiration or from bathing or if it becomes loose, soiled,
or if there is any newly occurring discomfort under the
dressing. Once you're ready to begin, find a clean well-lighted
place to work. Your living room, dining room, or bedroom is
best. Avoid changing the dressing in the kitchen or bathroom due to
the fact germs are usually located in these areas. Make sure you
have all your supplies then wash your hands briskly for a minimum of 15
seconds. And then dry them with a clean towel. Let's talk
a minute about clean versus sterile. Sterile means absolutely no
bacteria or germs. When you wash your hands with soap and rinse with
running water, your hands are clean but not sterile. You still have
germs on your skin that live there normally. You will be using
sterile supplies in the dressing change procedure and learning what is called
sterile technique using sterile gloves on both your hands. Now let's
look at removing the old dressing but first, a word of
caution. Never use scissors to remove the tape or dressing from your
catheter. The risk for cutting the catheter is high which could
result in complications and the catheter will have to be removed. Place
a linen protector or clean towel under your arm or shoulder. Wear
non-sterile gloves for this step. These gloves come in a box much
like tissue paper. Carefully remove the old dressing. It
may help to remove the tape if an alcohol or adhesive remover wipe is used to
wet the bottom piece of tape then use the wipe to help release the adhesive on
the bandage itself from the skin. Start at the bottom of the
dressing removing the base tape.
^M00:02:22
[
Pause ]
^M00:02:48
When you get to the
catheter extension, push down the tubing with one finger as you pull up on the
tape.
^M00:02:55
[
Pause ]
^M00:03:00
And then work around the
outer edges. As you move up to the hub and sutures, push down on
them with one or two fingers to hold them in place while removing the rest of
the bandage. Use one hand to push the skin down and the other hand
to pull up the dressing toward the center. This will keep you from
pulling too much on the patient's skin.
^M00:03:27
[
Pause ]
^M00:03:35
Now examine the
insertion site well. Look for redness, swelling, pain or discharge
on the skin around the catheter insertion site. Next, check the
stitches. The stitches hold the catheter in place. There
are usually three. The site stitch and two wing stitches. All
three must be intact and in the skin. If you see any problem, finish
changing the dressing and then call your doctor or infusion therapy
nurse. Now, discard your gloves and wash your hands
again. Or use the antiseptic hand gel provided in the dressing
kit. Peel the package open, pick up the paper wrapped kit and place
the plastic container to the side. You can use this as a trash
container. Touching only the outside corner of the wrapper, open it away
from you first. Use the antiseptic hand gel provided in the dressing
kit.
^M00:04:39
[
Pause ]
^M00:04:47
Now pick up the sterile
glove package and place it away from the rest of the kit. Then
continue opening each corner of the wrapper using only the outside corner edges
of the wrapper and pull all four corners away. Remember that you
cannot touch anything inside the sterile field with your clean bare
hands. If you forget and touch, you have contaminated the contents
and should dispose of the kit and open a new one. Now pick up the
sterile glove package. Keep this package away from the rest of the
kit and carefully open up the folded flaps of the package. The
gloves are packaged with the inside cuff turned out. So you can pick
up the folded edge of the glove and still keep it sterile. Pick one
glove up by the cuff, lift it clear of the table and hold it out away from your
chest. Insert your dominant hand into the glove. Next,
with the sterile glove hand, slip your fingers under the cuff of the second
glove and slip your other hand into the glove. Be careful not to
touch anything outside the sterile field of the dressing kit with your gloved
hands. If this occurs change your gloves right away with a new pair
of sterile gloves. This includes not touching the patient's skin or
the catheter itself with your sterile gloves. Before we continue,
let's take a look at what's inside the dressing kit. We'll find two
Q-tips, a package of antiseptic swabs, extra tape, label, scissors, a
protective skin barrier film swab, and a dressing bandage. There are
two types of dressing kits. One kit will have a clear bandage with
an attached gel antiseptic pad. The other kit has a separate
antiseptic gauze disc pad. The bandage is not included in this
kit. Most patients will use the clear dressing which can stay on for
a week at a time. If this isn't tolerated for any reason such as
perfuse sweating, the patient will be switched by the infusion therapy team to
the gauze dressing. This type of dressing must be changed twice
weekly. Now to continue, pick up the antiseptic solution package,
use the scissors to cut off the top end of the package. Now insert
the two Q-tips into the pack. Clean with the three large chlorhexidine swab sticks first. Pull out
one swab stick and start scrubbing at the insertion site. Move
outward to include the hub and stitched wings. And then continue
scrubbing in a back and forth motion outward in widening circles. Be
sure and clean all the skin and catheter that lies under the dressing.
^M00:08:03
[
Pause ]
^M00:08:15
Discard the swab when an
area of at least 3 to 4 inches out from either side of the center of the
catheter has been cleaned. Repeat using all three swabs.
^M00:08:30
[
Pause ]
^M00:09:53
Next, use the two Q-tips
to better clean the hard to reach areas of the insertion site, the stitches and
under the catheter wings.
^M00:10:03
[
Pause ]
^M00:10:28
Once all the swabs and
Q-tips are used, you must wait at least 2 full minutes to allow the site to air
dry. This tip is very important for several reasons. It is
during the drying period that the antiseptic kills the germs on the
skin. It also allows the antiseptic to stick to the skin cells
giving longer lasting protection against infection. Also if a
dressing is placed over the antiseptic while it is wet it can cause skin
irritation and redness. Now, pick up the pack of no-sting skin
barrier which is used to help protect the skin from the adhesive, cut open this
pack with the scissors provided and swab the entire edges of the cleaned area.
^M00:11:17
[
Pause ]
^M00:11:24
Do not wipe the
insertion site area so the antimicrobial pad included in the bandage dressing
will be effective in killing germs on the skin for the next 7 days.
^M00:11:35
[
Pause ]
^M00:11:48
Allow about 15 seconds
to dry. The next step is to apply the dressing
cover. Most patients will use the clear dressing. Some
will need the gauze dressing. Before placing either dressing if your
catheter is in your arm, extend your arm fully out straight. If your
catheter is under your collar bone, turn your head to the opposite side and
place your hand on your hip pulling your shoulder back. These
positions will stretch your skin out and keep your dressing from being too
tight and pinching your skin. For the clear transparent dressing, first
remove and discard gloves. Pick up the clear
dressing. Peel the plastic backing off and hold the edges of the
dressing. Center the antimicrobial gel pad over the insertion site
and center the V-cutout over the extensions. Do not stretch the
dressing or it will pull on the skin. Press the dressing down onto
the skin, starting at the center and then move outward toward the
edges. Continue peeling the paper off and pressing down the edges of
the dressing.
^M00:13:20
[
Pause ]
^M00:13:35
Pull the piece of tape located
on the bandage with the V cut out of it. You can trim the V larger
if needed. Slip this tape up under the catheter extension and
slightly overlap the dressing. Press down onto dressing.
^M00:13:52
[
Pause ]
^M00:13:58
Write on the label provided
the date, CVC, and your initials.
^M00:14:04
[
Pause ]
^M00:14:17
Place along the lower
edge of your dressing and cover it with a strip of clear plastic tape.
^M00:14:26
[
Pause ]
^M00:14:41
For the twice weekly
gauze dressing, keep the sterile gloves on. Peel open the small round antimicrobial
disc. Place this disc with the white side down and the blue tinted
shiny side up around the catheter insertion site. This doesn't stick
to the skin, so be careful not to move. You can also use the scissors
provided to cut the opening on the disc larger for larger
catheters. Remove and discard the gloves. Pick up the
gauze dressing and remove the paper backing. Center the dressing
over the insertion site and press the center down onto the
skin. Continue peeling the paper off and pressing down the edges of
the dressing.
^M00:15:46
[
Pause ]
^M00:15:53
Pull the piece of tape
located on the bandage with the V cut out of it. You can trim the V
larger if needed.
^M00:16:00
[
Pause ]
^M00:16:07
Slip this tape up under
the catheter extension and slightly over lap the dressing. Press
down. Write on the label provided the date, CVC, and your initials.
^M00:16:28
[
Pause ]
^M00:16:36
Place along the lower
edge of your dressing and cover it with a strip of clear plastic
tape. You are done. Make sure the dressing kit you
receive when picking up your supplies is the one your infusion therapy nurse
has recommended for you. [Background music] Let's review
some of the most important points. Before changing your dressing,
make sure you have all the supplies you need. You will need to
change your dressing once or twice a week depending on the type of bandage
dressing you use. In addition, you should change the dressing
anytime it becomes wet, soiled, loose, or if there is a new discomfort under
the dressing. Change the injection cap every week when not in
use. Flush injections are usually given daily or after catheter
use. Keep your dressing dry. Protect the dressing with
plastic wrap when bathing and never submerge your CVC under
water. After placement, some patients may have bruising or soreness
for a few days, this is normal. However, notify your doctor if you
develop any of the following problems later. If the site becomes
infected, in other words if there is redness, pain, or drainage, if you have a
fever of 101 degrees or more, if there is a new tenderness anywhere around the
area of the catheter, if there are loose or missing stitches, if the catheter
is leaking or if it is clogged, if you notice swelling or skin discoloration on
your neck, chest, or arm where the catheter is located. You should
also remember that you are not alone. Your health care team is
always here to help. You can also view this tape as often as you
like and you have the patient guide to refer to at home. You can
also purchase this video from the
©2009
The University of
1515
1-800-392-1611 (