Central line dressing question

[schnookimz]

My charge nurse has been encouraging me to change central line dressings once a day or once every two days--even when the dressing is clean, dry, and intact.

Facility policy says it needs to be changed once every 7 days as long as it's clean, dry and intact.

Obviously we can change it more frequently as needed.

Now my question: is it better to apply a clean dressing often (even when the old dressing is clean and only 24-48 hours old) or is it best to leave a clean dressing alone so as not to continuously reopen the dressing and possibly introduce new germs to the site?

[Asystole RN]

I will have to find the study but I remember that an unscheduled dressing change, for any reason, increased the likelihood of infection by something like 3 fold.

The CDC and INS hold domain over this topic and 7 days for a TSM dressing unless soiled or damaged is the standard of care.

Asystole RN BSN, RN, CRNI, VA-BC

[KelRN215, BSN, RN]

I will have to find the study but I remember that an unscheduled dressing change, for any reason, increased the likelihood of infection by something like 3 fold.

The CDC and INS hold domain over this topic and 7 days for a TSM dressing unless soiled or damaged is the standard of care.

Asystole RN BSN, RN, CRNI, VA-BC

I imagine "any reason" doesn't include "there was C-Diff diarrhea on the dressing". Because we've had a baby with that issue lately.

[suanna]

Depends on your central line. I.J. lines often need changed more frequently do to the drool factor. Even if the dressing remains intact a lot of oral stuff can drift right to your line site. A PICC line- once a week is plenty as long as the dressing is dry and intact. Sub C- it depends on the patient, but it is usually somewhere in between I.J. and PICC. Do you use those spiffy bio-inhibiting discs around the line and under the dressing?- They can greatly reduce the infection factor. The auto-swabbers (I don't know the official title)- you know ,the alcohol infused port caps also can limit line sepsis- but do nothing for dressing effectiveness. As folks have said-I'm sure there is a clear written policy where you work.

[Asystole RN]

I imagine "any reason" doesn't include "there was C-Diff diarrhea on the dressing". Because we've had a baby with that issue lately.

If you have C-Diff diarrhea on a dressing is the central line more likely or less likely to develop an infection?

The study was not focused on reasons why to change the dressing, only that is was being changed. This includes being soiled, falling off etc. All good reasons to change the dressing.

[Asystole RN]

Depends on your central line. I.J. lines often need changed more frequently do to the drool factor. Even if the dressing remains intact a lot of oral stuff can drift right to your line site. A PICC line- once a week is plenty as long as the dressing is dry and intact. Sub C- it depends on the patient, but it is usually somewhere in between I.J. and PICC. Do you use those spiffy bio-inhibiting discs around the line and under the dressing?- They can greatly reduce the infection factor. The auto-swabbers (I don't know the official title)- you know ,the alcohol infused port caps also can limit line sepsis- but do nothing for dressing effectiveness. As folks have said-I'm sure there is a clear written policy where you work.

There is a difference between routine dressing changes and dressing changes due clinical indication.

IJ dressings do have the tendency to become soiled or damaged more frequently but without clinical indication the 7 day rule applies.

[iluvgusgus]

Perhaps you should print out an EBP article and the hospital's policy about this and leave it on her desk...

[schnookimz]

Hospital policy is 7 days and yes we do have the blue discs.

[vintage_RN, BSN, RN]

My hospital just introduced this new thing for PICCs and central line dressings where there is no need for a stat lock anymore...the tegaderm dressing has a gel-pad of chlorohexadine attached to it which secures the line in place and continuously releases chlorohexadine over the 7 days....haven't seen them on my unit yet but apparently we're getting them...sounds interesting...

to answer your question which has already been answered...the more you access the line there is increased risk of infection so I would just follow policy, or change it q7days which is pretty standard.

[canned_bread]

I would also be concerned about skin intergrity from repeated dressing changes.

[edmia, BSN, RN]

My hospital just introduced this new thing for PICCs and central line dressings where there is no need for a stat lock anymore...the tegaderm dressing has a gel-pad of chlorohexadine attached to it which secures the line in place and continuously releases chlorohexadine over the 7 days....haven't seen them on my unit yet but apparently we're getting them...sounds interesting...

to answer your question which has already been answered...the more you access the line there is increased risk of infection so I would just follow policy, or change it q7days which is pretty standard.

Yes. That's the kind of dressing we have. No need to go hunting for those bio patches ... There were never enough to go around. This all in one dressing sticks better and more often make it the 7 days -- unless it's an IJ or other unfortunate placement or high humidity patient of course. Love them.

[Tomo21088]

I know your charge nurse probably has good intentions on wanting central line dressings changed so frequently,but you should always follow your policy. Most policies will state a clause "and PRN if site is visibly soiled". So, as long as it is clean, I would not change it until the date it is due to be changed. Frequently exposing the site to open air just puts the patient as more risk of infection. If your charge nurse has a problem with that, I would bring it up with them first and if they still want you to change so frequently I would talk to my clinical director.

[KelRN215, BSN, RN]

If you have C-Diff diarrhea on a dressing is the central line more likely or less likely to develop an infection?

The study was not focused on reasons why to change the dressing, only that is was being changed. This includes being soiled, falling off etc. All good reasons to change the dressing.

Ok, fair enough, I see the point. So changing the dressing early in and of itself is not the causative factor of the infection but the reason for it being changed early more often than not increases the risk of infection. I have a 7 yr old patient who I can't believe has not landed himself in the ICU with sepsis d/t his central line. Mother has often taken it upon herself to change it barehanded with no mask and the KID has, twice, attempted to change it himself. I went over there today and he had put a bandaid (with superhero cartoon characters, naturally) on it to hold it down on one side and every other edge was off.