Central Line Securement Devices

Do you place the securement device for a central line under the transparent dressing or can it be outside the transparent dressing?

 

I've always placed it under the dressing and have only seen it that way.

Under the dressing.

Thanks! 

My apologies, I should have been more specific. 

Does anyone make it an issue if the entire securement device is not under the transparent dressing? Like for and IJ where one is dealing with limited space.

Moe

Infusion Nursing Society has standard of practice recommendations that IV securement device should be covered totally with transparent or gauze dressings + lists frequency of change :

Vascular Access Device (VAD) Assessment, Care, and Dressing Changes S81

Typically you want the entirety of the securement device to be completely underneath the dressing, both for reliable securement reasons but also infection prevention reasons. On occasions I have seen part of the securement device outside of the dressing, but this is something I try to avoid. Agreed it can be a challenge with certain lines, or PICC lines with long ELs.