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Hello. If you are watching this video it is because you or someone you care about has
a central line. This video is meant to be an introduction to proper line care, and is
not intended to teach you how to perform the care. While healthcare providers have received
training regarding care of a central line, there can be variation from provider to provider,
and from setting to setting. For that reason it is important for you to be familiar with
the care so you can speak up if you question any unusual practice. You are the one consistent
that can watch and ensure the line is cared for properly.
The dressing needs to be changed every 7 days or sooner if the dressing gets damp, dirty,
or starts to come off. The dressing is a protective barrier between the catheter and the bacteria
in our environment. During the dressing change the skin under the dressing is again disinfected
to kill the bacteria that reside normally on our skin.
Before the dressing change can begin all the necessary supplies need to be obtained. Common
items include: chlorohexadine which is the skin disinfectant, a new dressing, a mask
for the nurse and the patient, and sterile gloves. The supplies are opened and arranged
on a sterile towel or field.
Before removing the old dressing the nurse should put on a mask and offer one to every
person in the room watching the procedure. If people in the room are not wearing a mask
they will be instructed to turn their face away from the procedure area. After putting
on the mask it is important that hand hygiene occurs. Non-sterile gloves are worn during
the removal of the old dressing. It's normal to feel minor discomfort when the old dressing
is removed.
As the dressing is being removed, the site is assessed for any redness or drainage, both
of which could be a sign of infection. It is important to tell the nurse if you are
having any pain at the site as that is not normal.
Once the old dressing is off, the non-sterile gloves are removed and replaced with sterile
gloves. After the sterile gloves are on only the sterile equipment can be touched.
The first step is to clean the skin that was under the dressing with the skin disinfectant
-- you scrub the area around the line up and down, back and forth for 30 seconds and after
once along the length of the line. Allow the skin disinfectant to air dry. No one should
fan or blow on the site to speed the drying.
Once the site is clean and dry the dressing is applied. You may see some variations in
how the dressing is applied and anchored into place. The goal is for the dressing to cover
the insertion site and the catheter and be secure to the skin. Labeling the dressing
with the date the dressing was changed is a good reminder for the next dressing change
in 7 days.
Immediately after the dressing change is a good time to also change the access caps of
the catheter. When changing the caps it is important to have a new sterile cap all primed
with normal saline. Your nurse will begin by making sure the line is clamped. While
wearing non-sterile gloves, the will unscrew the old cap. Then an alcohol pad will be used
to scrub the hub of the catheter for 15 seconds. Finally, the hub will be covered with a new
sterile cap.
If you have any questions regarding dressing and cap changes, please ask your healthcare
provider. Thank you.