Central Line Dressing Changes

I would start looking around this site: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/ImplementtheCentralLineBundle.htm

http://lmgtfy.com/?q=CVC+dressing+changes

I just had to try this out. :-)

Actually if you dig a little deeper and read the PDF files they have more recent citations. I'm not sure if any really new studies exist since all the older ones seem to have come to the same conclusion.

Every place has different policy regarding frequency as well as brand and what is provided in the change kit. Our facility implemented the use of the Biopatch which is an added level of infection prevention. I would consult your most recent textbook for nursing procedures for what is the accepted standard. This would be more relevant than one facility/nurse's standard. Unless, of course, you are reviewing a particular facility specifically.

Look to the INS for guidelines.

Thanks for all your replies.

However, I have looked at the INH's recommendations but they are more concerned are about insertion of CVADs not maintenance. Is there anywhere I can find recent literature on "maintenance bundles?"

Also, I am trying to see if my school's library has a copy of the INS' Standards of care.

I am still looking, so please keep the recommendations flowing.

Thanks for all your replies.

However, I have looked at the INH's recommendations but they are more concerned are about insertion of CVADs not maintenance. Is there anywhere I can find recent literature on "maintenance bundles?"

Also, I am trying to see if my school's library has a copy of the INS' Standards of care.

I am still looking, so please keep the recommendations flowing.

I doubt that your library would carry a copy of INS standards of care, however, it is those very same standards that you and the organization that you work for, should be following. Infusion Nurses Society (INS) is that "benchmark" that courts look to for IV therapy practice. You can find and purchase a copy of those standards @ www.ins1.org

Also, please know that gauze under a transparent dressing is a no-no, unless it is there for the first 24 hours after placement, and, if an IV catheter was placed utilizing sterile techniques, the dressing changes to that catheter should be performed sterilely as well... This means that one MUST wear a mask when doing a drsg change.

The frequency of the dressing change has really not been established and continues to be controversial topic....However both INS...and the CDC have recommendations that organizations can look at and then make their decisions from there

1. generally speaking you do not want to leave a TSM (transparent semi-permeable membrane)dressing on for more than 7 days..and that has to be without any gauze under the TSM dressing..b/c then it interferes with its function and basically it is just expensive tape.. you can pad the tails of the CVC or PICC if needed as long as it is no under the TSM...so some hospitals choose to change every 7 days some choose to change twice weekly ect

2 If the pt needs gauze at the insertion site either b/c it is a new Central line and/or the site is oozing then that dressing should NOT stay in place for more than 48 hrs..bacteria counts are higher with the use of the gauze after the 48 hrs than the TSM. INS also states this as a standard

3 INS and CDC recommend the use of Chlorhexadine (CHG) for routine site care..they also have alternate agents for allergies, such as povidone iodine...CHG is a great product but must be used thoughtfully..a minimum of a 30 second scrub is needed..you can scrub in a back and forth direction and you must allow the CHG to dry completely..that is crucial...CHG gets all the same bacteria and fungus as the povidone iodine BUT it persists on the skin and that is why it is far superior and works for hours and hours as opposed to 2 mins

4 The dressing needs to be done in a sterile manner and never should be a clean technique..a mask needs to be worn..and the pts face needs to be kept away from the site during the dressing change....I personally wear the mask when I change the caps as well..caps needs to be changed at least every 7 days but no more frequently than every 72 hrs