Central line procedures. Dressing change. This video will review the steps required for two
people to complete a dressing change of a central vascular access device or CVAD.
It is important to remember that this procedure uses aseptic non-touch technique. Your child's
dressing needs to be changed every seven days, or as needed, if it becomes soiled or wet.
Central line procedures require two caregivers. A main person and a support person. Your child's
healthcare team may teach you how to complete central line procedures at home.
It is important to follow all procedures carefully to keep your child safe.
Do not perform these procedures unless instructed to do so by your child's health
care provider. A central vascular access device, or central line, has the following parts:
clamps
lumens
catheter
access caps
insertion area or exit site
dressing
and securement device.
The caps are considered key parts of the central line. The insertion, or exit site, is considered a key site.
Environment. Please see the introduction video on preparing your environment for a CVAD procedure before watching this video.
First, locate an area to perform the procedure and the support person who will help you. Find a quiet space and remove any pets or other
children. You need to limit the number of people in the room where the procedure is taking place.
Reduce air drafts by closing windows and doors and turning off fans. Find a stable, wipe-able
work surface to use as your general aseptic field, such as an unused dedicated cookie tray,
and remove any clutter. Clean the work surface with a disinfectant wipe and allow it to dry.
Place a garbage bin and hand sanitizer within reach. Make sure to remove any jewelry and tie
back long hair before starting the procedure. Then perform hand hygiene by washing your hands.
It is best to use soap and water especially if your hands are visibly soiled.
You may use hand sanitizer if your hands appear clean.
Rub your hands together until they are dry, ensuring you wash every surface of your hands.
Supplies. Gather your supplies and place them on the general aseptic field. You will need:
clean gloves, sterile gloves, three chlorhexidine with alcohol or CHG sponges or sticks, your choice
of dressing, an appropriate securement device, masks for everyone in the room,
and a sterile drape may sometimes be used as an additional work surface
but this is optional. Keep all the supplies in their packages until you are ready to use them.
This is known as the microcritical aseptic field. After gathering your supplies, perform hand hygiene
then put on your mask. Everyone in the room should put on a mask. If your child is too young or unable
to wear a mask, have the second person support them in turning their head away from the CVAD.
Wearing a mask will protect the aseptic field. Make sure your child's clothing will not get in the
way of the procedure. Perform hand hygiene after touching your face and then put on clean gloves.
The second person also needs to wash their hands and put on clean gloves, this will allow them to
be prepared to hold the line if you are unable to keep the line secured with the securement device
during the procedure. Performing the procedure. Your support person can help keep your child
as calm and still as possible if needed. If they need to hold your child still, they can dedicate
one hand for holding and keep the other hand clean to help hold the central line during the procedure.
The support person may find it helpful to hold that hand up. Remove the old dressing.
Check the key site and the skin around the CVAD. Look for signs of infection, redness,
irritation or discharge. Make sure not to touch the site with your hands. if possible
leave the securement device on to prevent accidental dislodgement and change it after.
If the securement device is under the dressing, remove the securement device now.
The second person can help hold the line so it doesn't move get dislodged or contaminated
The gloves you use to remove the old dressing are now contaminated. Remove them, perform hand hygiene
and put on a new pair of clean gloves. Use the CHG sponge, or swab stick, to cleanse the area.
If you are using the sponge, open it up, and while pointing the sponge downwards, crack the sponge
so it fills with the liquid. If you are using the swab stick, carefully take it out of the packaging.
If the line is out of the securement device, the second person can lift the CVAD
off the skin to keep it elevated. Remember not to touch the key site with your hands. Scrub the skin
using friction around the CVAD from the exit site to approximately five centimeters beyond
the dressing borders in a back and forth motion, in two directions for 30 seconds. For example, up
and down and side to side for 30 seconds. Vigorous scrubbing will allow the solution to effectively
clean the skin. Then throw the sponge or swab stick into the garbage. Open two additional chlorhexidine
sponges or swab sticks. Use the two swab sticks to clean both sides of the central line,
starting closest to the child and moving up the catheter for an additional 30 seconds.
If the CVAD is looped when placed against the child's skin a longer portion of the CVAD must be cleaned.
Allow your child's skin and the CVAD to dry completely to ensure bacteria is removed.
This takes at least two minutes until the skin does not appear shiny. Your partner can keep track
of the time. Applying a dressing on damp skin will increase the risk for skin irritation.
Do not fan or blow on the site or wipe off the cleaning solution to speed up drying
as this will contaminate the area. Remove the gloves and throw them away.
Perform hand hygiene. The next steps of the procedure are considered critical steps because the key site,
the insertion site, is exposed. Take care as you perform each step to prevent any contamination
Slowly and carefully open the dressing package, ensuring that the dressing falls flat on the
packaging. Or, you may choose to open your package of sterile gloves first and then
safely drop the dressing onto your sterile glove field using aseptic non-touch technique.
Perform hand hygiene again, and this time put on your sterile gloves. For instructions on
how to properly put on sterile gloves, please watch the video on sterile gloving procedure.
If helpful, you may move the dressing with your gloved hand.
Peel off the paper backing of the dressing.
Apply the dressing making sure the site and catheter loop are covered.
It is important to position the CVAD so that the key site is visible through the window of
the dressing. Pay careful attention not to stretch the dressing when applying it and make sure the
dressing is well adhered to the skin. Place your hand over the entire dressing for 15 to 30 seconds
to help the dressing stick to the skin. Peel off the paper around the window of the dressing.
Remove the CVAD from the securement device. Use the additional pieces of the dressing, or another
adhesive tape, to cover any openings around the catheter by placing one strip under the line and
another over the line. Remove the securement device from the skin and apply a new one.
If using a securement device, it can be helpful to secure the line
in the new device first and then stick it to the skin.
Remove your gloves. Perform hand hygiene and then remove your mask.
Perform hand hygiene again.
Clean up. Discard the used supplies into the garbage and clean your general aseptic field.
Your dressing change is now complete.
Remember these key points:
Maintain aseptic non-touch technique throughout the procedure.
Assess the site for signs of infection. Clean the skin and the line for 30 seconds each
and allow to dry for at least 2 minutes. Perform hand hygiene at appropriate times. Please speak
to your child's health care provider about this video before performing any of these procedures.