Central line dressing days

ixchel · Mar 24, 2015

I agree that the risk of infection is increased with scheduled dressing changes if it just got changed the day before, but the chance that it will actually be changed is also increased, which may actually decrease the risk of infection. Not all nurses have the time to worry about looking at IV site dates/times and changing lines/dressings. The weekly set date allows for easier auditing and checking and one nurse could go around and change lots of them.

We put the change date on the dressing, so if it was changed PRN (I.e. If it was non-occlusive), it will be changed 7 days after the changed date written on the dressing. No unnecessary changes here.

KelRN215, BSN, RN · Mar 24, 2015

They are changed q 7 days. Earlier if they are soiled or non-occlusive. I work in pediatrics so the kids scratch them off more frequently than an adult probably would. I have some kids who usually end up needing the dressings changed twice/week. PICC dressings are changed after 24 hours if there if gauze is placed over the insertion site and then weekly. When I worked in the hospital we DID have standard days for CVL cap changes- Sunday and Thursday. For those who have floors that do them on set days, what do you do if the patient comes in on Saturday and says "my visiting nurse just changed the dressing yesterday" and the patient KNOWS it's only due every 7 days? If I were the patient in that situation you'd be met with an "oh hell no you are not changing my dressing when it was just changed." If you put him on a Sunday schedule that's going to mess him up when he goes home. Speaking as a visiting nurse I'd find this rather annoying. Or what if the patient doesn't have a visiting nurse and usually gets his dressing changed at the Oncology clinic? They're not open on Sundays so his schedule would be all messed up in that situation too.

FlyingScot, RN · Mar 25, 2015

Tegaderm: every seven days unless loose or soiled.

Tegaderm with gauze underneath or plain gauze: every three days unless loose or soiled.

Caps are changed weekly with the dressing change.

I can't wrap my head around removing a perfectly good dressing just to match a facility schedule. It increases the risk of infection and it has to be murder on the patient's skin.

anon456, BSN, RN · Mar 25, 2015

Changed every seven days, sooner if needed. This includes the changing of the caps. Inspected every 2 hours by the bedside nurse (hourly if fluids are running). Inspected daily by a member of our IV team. Also per policy they must be checked for blood return and flushed with heparin every shift if not being used during that time period.

We have not had a hospital acquired central line infection in months on the unit, a fact we are very proud of. Our system works.

blondy2061h, MSN, RN · Mar 25, 2015

48 hours post insertion, q7d, and PRN. No set day weekly. That would not be a pleasant day to work. I can't imagine changing someone's dressing on Sunday if it gets wet in the shower, only to have to change it the next day because it's Monday.

blondy2061h, MSN, RN · Mar 25, 2015

We change them all on Sunday. If a patient has one placed on Saturday, then we still change it on Sunday to keep everyone on the same schedule. If it was found to be no longer intact on Friday and changed, we still change it again on Sunday to keep it "on schedule." It can be annoying in those situations where it was just changed or placed the day before. Exceptions to the Sunday change would be a soiled, non-intact dressing or bleeding/infected line...in those cases, we change it as needed and then...Sunday :)

This is not evidence based. Changing a new, dry, and intact dressing simply due to the day of the week is just putting that patient at risk for infection due to more exposure.

BrandonLPN, LPN · Mar 25, 2015

What's the rationale for picking a day, say Sunday, for all central line dressing changes instead of doing them based on when it was inserted? Is it because they were being forgotten or overlooked, and making Sunday the "change day" supposedly eliminates that?

We did something like that for our indwelling catheters. All of them get changed on the 25th of the month, even if we just did a PRN change the day before. It just seems silly to me. As though we're incapable of following individual schedules for individual patients.

alprn1414 · Mar 25, 2015

we used to change ours on fridays but i guess none of the nurses could do it correctly and there were too many infections so the IV team has to do it from now on!!!

ixchel · Mar 25, 2015

We did something like that for our indwelling catheters. All of them get changed on the 25th of the month, even if we just did a PRN change the day before. It just seems silly to me. As though we're incapable of following individual schedules for individual patients.

This makes me curious - how was your cauti rate?

BrandonLPN, LPN · Mar 25, 2015

This makes me curious - how was your cauti rate?

I didn't notice a change one way or the other, of course I don't have access to the raw data.

Our rate for UTIs for patients without indwelling catheters was high. We had mostly male residents, and the aides put "wraps" on incontinent residents where a brief is tightly wrapped around the member and scrotum. Then you dress the resident in another brief like normal. Suprisingly, I've never seen skin breakdown occur as a result, but I did notice these residents have high UTI rates. I can only imagine because it keeps the urine tight against the member. Plus the whole point was to decrease number of times the aides changed briefs, so they only got changed once a shift in most cases. I didn't allow the CNAs to do it on my shift, but it was allowed overall.

ngodin · Mar 25, 2015

They wouldn't have already been done because I am the only one in the hospital that does them (with the exception of the rare one due on the weekend). We are a small hospital and have only 8-10 PICCS on average, so it wouldn't take long for me to do those. I just wonder if anybody is at a hospital that has changed to this method and seen a change in CLABSIs.

ngodin · Mar 25, 2015

Most of the hospitals that are doing this have one nurse (or team, depending on size of hospital) that does them all, taking that task away from the primary nurse. In my hospital, I am the only nurse that does them (with the rare exception of one due on the weekend)....and I am also the WOC and Diabetes Educator here as well. I just want to know if anyone that has changed to this model has seen an increase in CLABSIs when they did.