EQUIPMENT
Mask (for self and assistant)
Cleansing solution(s) for IV site
Gloves, nonsterile (exam)
Dressing materials (as prescribed by agency procedure)
Gloves, sterile
Sterile scissors (if necessary)

NOTE: Some of the materials may come in a prepack-
aged kit.

SAFETY

1. Assess for any allergies to tape or cleansing solution.
2. For infant, young child, or child unable to cooperate,

use an assistant to help restrain the child. Protects the
integrity of the central line.

PROCEDURE

1. Gather equipment; clean bedside stand. Promotes orga-

nization and efficiency.

2. Prepare child and family. Consider having someone to

support or comfort the child during the procedure.
Enhances cooperation and participation and reduces
anxiety and fear.

3. Wash hands. Reduces transmission of microorganisms.
4. Position child as needed to perform the procedure.
5. Put on mask and nonsterile gloves. (Assistant should also

wear a mask.) Carefully remove old dressing including
any Steri-Strips. Reduces transmission of microorgan-
isms and protects nurse from contact with body fluids.
Protects integrity of central line.

6. Assess site. Examine for redness, swelling, and drainage.
7. Remove nonsterile gloves. Wash hands. Reduces trans-

mission of microorganisms.

8. Open supplies and set up sterile field.
9. Put on sterile gloves. Reduces transmission of microor-

ganism, which could lead to infection of central line or
sepsis.

10. Cleanse insertion site and surrounding area with solu-

tion(s) prescribed by agency procedures. With each
swab begin at the catheter exit site and cleanse outward
in a circular pattern without returning to the center.
Maintains asepsis by cleansing from least contaminated
area to most contaminated area. (Figure 20A)
a. A number of solutions may be used, singly or in com-

bination, for cleansing the site. These include 2%
chlorhexidine (aqueous), 10% povidone-iodine (or
other iodophor), 70% alcohol, 0.5% chlorhexidine in

70% alcohol, 4% chlorhexidine in a detergent base
(Hibiclens), alcohol-acetone. Research shows 2%
chlorhexidine to be the most effective, however, it is
not available in the United States and Canada
(Dickinson, 1997). Povidone-iodine must be allowed
to dry to be effective. If Hibiclens is used, it is rec-
ommended that it be removed from the skin using
sterile water (Freiberger, 1994).

b. One procedure is to cleanse the site with 70% alcohol

followed by 10% povidone-iodine. Alcohol applied
after povidone-iodine negates the fungicidal effects of
the povidone-iodine.

11. Clean catheter last, moving from insertion site up

catheter by rolling swab (Figure 20B)

12. Apply skin prep to area avoiding

1

/

2

-inch area around

the catheter exit site.

13. Apply ointment as prescribed or per agency procedure.

(Figure 20C)

14. Apply new sterile dressing as specified in agency policy.

NOTE: Type of dressing specified for peripherally
inserted central catheters (PICC) and tunneled
catheters may differ. (Figures 20D and 20E)

54

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 19

SKILL 19

Dressing Change Central Venous Line
(Tunneled, Percutaneous, and Implanted)

FIGURE 20A Cleanse insertion site and
surrounding area by beginning at the
catheter exit and moving outward in a circu-
lar pattern without returning to the center.

continued

DOCUMENTATION

1. Dressing change and time.
2. Condition of site.

55

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

FIGURE 20B Catheter is cleaned using
upward strokes.

FIGURE 20C Ointment is applied to site
(per agency protocol).

FIGURE 20D Split 2

× 2 gauze surrounds

catheter at site.

FIGURE 20E Clear occlusive dressing is
applied.

SKILL 19

SKILL 19

Dressing Change Central Venous Line
(Tunneled, Percutaneous, and Implanted)