206 Section V ■ Vascular Access

E. Sterile Dressing for Surgically Placed

Central Venous Lines

Routine changing of central venous catheter dressings

depends on the type of dressing. Transparent dressings should

be changed at least every 7 days, and gauze dressings every 2

days. All dressings should be changed when damp, loose, or

soiled (2).

Equipment

Strict sterile technique is used for all central line dressings.

1. Antiseptic skin prep solution: Per institutional policy (e.g.,

10% povidone–iodine or 0.5% chlorhexidine solution)

2. Sterile gloves, mask, cap, and sterile gown (optional)

3. Scissors (optional)

4. Cotton-tipped applicator

5. 4- × 4-inch sterile gauze square

6. Dressing of choice

a. Semipermeable transparent dressing

b. Sterile 2- × 2-inch gauze squares or presplit 2- ×

2-cm gauze dressing

7. Normal saline or sterile water

8. Adhesive tape (if sterile tape not available, use fresh

unused roll)

Precautions

1. Procedure should be undertaken by trained personnel.

2. Ensure that all personnel wear masks if within 3 ft

radius of sterile area.

3. Use strict aseptic technique.

4. Remove dressing with care, to avoid cutting or dislodging catheter.

5. If it is necessary to clamp the catheter, close the clamp

on the catheter according to the manufacturer’s directions. If the catheter does not have a clamp, use a

rubber-shod clamp. Never place a clamp directly on

the catheter.

6. Never advance a dislodged catheter into the patient.

7. Do not place adhesive tape on silicone tubing because

this may occlude or damage the catheter.

8. Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment at the insertion site because

of the potential for promoting fungal infections and

antimicrobial resistance (2).

Technique

When a subcutaneous tunnel is used, occlusive dressing

should be applied to both the cutdown site and the catheter

exit site. The dressing on the exit site can be removed after

48 hours if there is no oozing.

1. Restrain patient appropriately, utilizing nonpharmacologic comfort measures.

2. Put on head cover and mask.

3. Scrub as for major procedure.

4. Put on gown and gloves.

5. Prepare sterile work area, using “no-touch” technique.

6. Remove old dressing and discard.

7. Inspect catheter site carefully (Table 32.4).

8. Culture site if there is drainage or it appears inflamed.

9. If area around catheter is contaminated with dried

blood or drainage, clean with diluted hydrogen peroxide/sterile water solution (1:1).

10. Remove gloves. Don sterile gloves.

11. Cleanse area with antiseptic solution, starting at catheter site and working outward in circular motion for 2 to

4 cm. Repeat twice. Allow area to dry.

12. Remove antiseptic with sterile water or saline gauze

and allow to dry.

13. Apply dressing of choice.

a. Clear, adhesive, hypoallergenic, transparent dressing allows for continuous inspection of catheter

insertion site, and is preferred (Fig. 32.10).

(1) If necessary, cut dressing to desired size.

(2) Anchor dressing to skin above catheter skin

entry site so that the point of skin entry is at the

center of the dressing.

(3) Remove remainder of adhesive backing while

applying dressing smoothly over site.

b. Occlusive gauze dressing

(1) Cut gauze halfway across, or use presplit gauze.

Place around catheter, as shown in Fig. 32.13.

(2) Cover remainder of external catheter length

(not hub) with sterile gauze.

(3) If sterile tape is not available, discard outer layer

of tape on roll.