Central line dressing days

ngodin · 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.

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.

Do-over, ASN, RN · Mar 25, 2015

We don't have set days, but it seems so rare to have a dressing last 7 days anyway - especially IJs in intubated patients... Like unicorns, subclavian lines are rare and beautiful things.

Coriander, BSN, RN · Mar 25, 2015

Dressings are every 6 days and prn. Lines and caps are changed every Monday and Thursday. RNs own their lines although the vascular nurse will sometimes do a change.

Patients who present with an outside line will have a picture taken (of the site) and the dressing changed.

musingmom · Mar 25, 2015

For what it's worth:

My ICU changes central line dressings on Sundays and PRN. If it was inserted on Saturday, it gets changes on Sunday. This does occasional result in additional dressing changes, but not many. Our SWAN sites get changed every 7 days anyway. There is evidence that 7 day dressing changes vs 3 day dressing changes only marginally improved infection rates... the chlorhexidine disks were much more successfull at improving infection rates. This was from a study in JAMA in 2009. Anyway, the consensus for our evidence based practice team was that the entire CVL bundle was necessary to prevent infection; and a standardized dressing change day did not increase infection rates. Our hospital (metro teaching hospital) has CLABSI rates lower than the national average, and my unit (1 of almost 10 different ICUs in this hospital) has not had a CLABSI in 8 months. Not all of our ICUs have a standardized dressing change day, but mine does.

DisneyNurseGal, BSN, RN · Mar 25, 2015

We do them every hospital wide on Thursday (or PRN as needed). This is shown to increase employee compliance with dressing changes, and to decrease confusion or misunderstandings as to when a dressing needs to be changed.

NurseSpeedy, ADN, LPN, RN · Mar 26, 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.

This was my take on why they would be scheduling them on a specific day rather than the seven day/prn rule. I feel that if we are marking our dressings the right way we should be able to note during our initial assessment for the day if it's due to be changed or not when it comes to a central line. I feel that the more we open up the dressing needlessly due to following the calendar for a specific day of the week puts the patient at a greater risk of infection. I understand that some hospitals want to have a specific nurse or team change the routine dressings, the only problem is there are other occasions when the dressing needs to be changed before that nurse or team is available and on a different day than scheduled and it throws the whole thing off. I do think with the use of computers we could still have one person doing the scheduled changes on a seven day basis, but that would also require every nurse that did a prn dressing change to enter that information into the program so a report could be run for the dressings that need to be changed on a specific day. Just an idea.

As for the urine catheter I agree that sometimes it doesn't make sense as to when to change them, especially if it was done the day before. I worked in a hospital and had a 400+ lb female who came in with a UTI and a catheter from her facility. Within 24 hours the primary care doctor ordered the catheter to be changed (duh) because it was inserted prior to the UTI (the woman always had a catheter due to medical reasons). So I removed it, she had been on abx treatment since admission and reinserted a new one using sterile technique (I know we always do this but I just want to clarify ahead of time that proper technique was used). The next day, the specialist rounded and ordered to remove and reinsert the catheter. I informed them that it had just be done the day before and the one prior to initializing treatment had been removed...they still wanted a new one again. No increase in the WBC count or anything, just wanted a second new catheter inserted. Didn't make sense to me, but that's what they wanted.

IVRUS, BSN, RN · Mar 26, 2015

We change them 24 hrs post insertion, and then weekly. And of course if non-intact. If the dressing becomes non-intact more than once, the MD has to replace the whole line.

If the patient is diaphoretic and the dressing becomes loose... your institution replaces the entire catheter????? Wow... How is the risk vs benefit justified here?

Here.I.Stand, BSN, RN · Mar 26, 2015

If the patient is diaphoretic and the dressing becomes loose... your institution replaces the entire catheter????? Wow... How is the risk vs benefit justified here?

Our CLABSI rate needed improvement. The rationale is replace the contaminated/potentially infected one under sterile conditions. To be honest I haven't read the research on it, but it's the policy our managers and infection control departments came up with.

sistrmoon, BSN, RN · Mar 30, 2015

This was my take on why they would be scheduling them on a specific day rather than the seven day/prn rule. I feel that if we are marking our dressings the right way we should be able to note during our initial assessment for the day if it's due to be changed or not when it comes to a central line. I feel that the more we open up the dressing needlessly due to following the calendar for a specific day of the week puts the patient at a greater risk of infection. I understand that some hospitals want to have a specific nurse or team change the routine dressings, the only problem is there are other occasions when the dressing needs to be changed before that nurse or team is available and on a different day than scheduled and it throws the whole thing off. I do think with the use of computers we could still have one person doing the scheduled changes on a seven day basis, but that would also require every nurse that did a prn dressing change to enter that information into the program so a report could be run for the dressings that need to be changed on a specific day. Just an idea.
As for the urine catheter I agree that sometimes it doesn't make sense as to when to change them, especially if it was done the day before. I worked in a hospital and had a 400+ lb female who came in with a UTI and a catheter from her facility. Within 24 hours the primary care doctor ordered the catheter to be changed (duh) because it was inserted prior to the UTI (the woman always had a catheter due to medical reasons). So I removed it, she had been on abx treatment since admission and reinserted a new one using sterile technique (I know we always do this but I just want to clarify ahead of time that proper technique was used). The next day, the specialist rounded and ordered to remove and reinsert the catheter. I informed them that it had just be done the day before and the one prior to initializing treatment had been removed...they still wanted a new one again. No increase in the WBC count or anything, just wanted a second new catheter inserted. Didn't make sense to me, but that's what they wanted.

We include in report the day the central line dressing is to be changed and also put it in our computerized orders.

firstinfamily, RN · Mar 30, 2015

WE still have an IV team in place who change all central line dressings and central line tubing. Nursing staff is not to touch either of these.