Checklist for Skill 1

Checklist for Skill 19. Dressing Change Central Venous Line (Tunneled, Percutaneous, and Implanted)

Name ______Date ______

School ______

Instructor ______

Course ______

Skill 19. Dressing Change Central Venous Line (Tunneled, Percutaneous, and Implanted)

/ Able to Perform / Able to Perform with Assistance / Unable to Perform / Initials and Date /

Safety

1. Assess for any allergies to tape or cleansing solution.
2. For infant, young child, or child unable to cooperate, use an assistant to help restrain the child. /
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Procedure

1. Gather equipment; clean bedside stand.
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2. Prepare child and family. Consider having someone to support or comfort the child during the procedure.
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3. Wash hands.
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4. Position child as needed to perform the procedure.
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5. Put on mask and nonsterile gloves. (Assistant should also wear a mask.) Carefully remove old dressing including any Steri-Strips.
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6. Assess site. Examine for redness, swelling, and drainage.
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7. Remove nonsterile gloves. Wash hands.
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8. Open supplies and set up sterile field.
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9. Put on sterile gloves.
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10. Cleanse insertion site and surrounding area with solution(s) prescribed by agency procedures. With each swab begin at the catheter exit site and cleanse outward in a circular pattern without returning to the center.
a. A number of solutions may be used, singly or in combination, for cleansing the site. These include 2% chlorhexidine (aqueous), 10% povidone-iodine (or other iodophor), 70% alcohol, 0.5% chlorhexidine in 70% alcohol, 4% chlorhexidine in a detergent base (Hibiclens), alcohol-acetone. Research shows 2% chlorhexidine to be the most effective, however, it is not available in the United States and Canada (Dickinson, 1997). Povidone-iodine must be allowed to dry to be effective. If Hibiclens is used, it is recommended that it be removed from the skin using sterile water (Freiberger, 1994).
b. One procedure is to cleanse the site with 70% alcohol followed by 10% povidone-iodine.
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11. Clean catheter last, moving from insertion site up catheter by rolling swab.
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12. Apply skin prep to area avoiding 1/2-inch area around the catheter exit site.
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13. Apply ointment as prescribed or per agency procedure.
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14. Apply new sterile dressing as specified in agency policy.
NOTE: Type of dressing specified for peripherally inserted central catheters (PICC) and tunneled catheters may differ.
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Documentation

1. Dressing change and time.
2. Condition of site.
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Permission to reproduce for clinical use granted.