{"id":1798,"date":"2018-08-14T11:28:53","date_gmt":"2018-08-14T15:28:53","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&p=1798"},"modified":"2019-09-30T14:26:08","modified_gmt":"2019-09-30T18:26:08","slug":"8-10-iv-site-dressing-changes","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/8-10-iv-site-dressing-changes\/","title":{"raw":"8.10 IV Site Dressing Changes","rendered":"8.10 IV Site Dressing Changes"},"content":{"raw":"IV site dressings are intended to stop the introduction of microorganisms at the IV insertion site, which can lead to blood infection, and to help to stabilize IVs to prevent micro-movements, which can lead to phlebitis. Some principles of IV site dressing changes are:\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Table 8.12 Principles of IV Site Dressing Changes<\/h3>\r\n<\/td>\r\n<\/tr>\r\n

Aseptic techniques must be maintained while doing dressing change.\r\n\r\nTape or other securement devices that are used under the dressing must be sterile.<\/td>\r\n\r\n
    \r\n \t
  • Preventing microorganisms into the client\u2019s vascular system = \u2193risk of infection at site \/ systemic.<\/li>\r\n \t
  • Remove old dressing with clean gloves.<\/li>\r\n \t
  • Sterile gloves or a non-touch technique to be used when taking off sterile securement strips or device.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Transparent semi-permeable (TSM) dressings.\r\n\r\nChanged every time the site is changed and prn.<\/td>\r\nSemi-permeable allows sites to \"breathe.\"\r\n\r\nTransparency allows clear visualization of insertion site.\r\n\r\nDressings provide protective function to prevent catheter migration via stabilizing and protection from microorganisms.\r\n\r\nIf the patient's skin is not intact and\/or there is allergy, consult agency guidelines for appropriate IV site dressing.<\/td>\r\n<\/tr>\r\n
If gauze is needed under the dressing, change dressing q48 hours.<\/td>\r\nExcess moisture and gauze act as a reservoir for bacteria.<\/td>\r\n<\/tr>\r\n
If excess hair needs to be removed, clip hair with scissors.<\/td>\r\nShaving may cause micro-abrasions, and intact skin is the body\u2019s first line of defense against bacterial migration.<\/td>\r\n<\/tr>\r\n
When cleaning use multi-directional friction:\r\n
    \r\n \t
  • Use 2% chlorhexidine \/ 70% isopropyl alcohol<\/li>\r\n \t
  • Clean beyond the size of the dressing<\/li>\r\n \t
  • Allow cleaning solution to dry (approx. 30 seconds)<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Reduce the microbes at the insertion site.\r\n\r\nDrying allows for maximum antiseptic activity.\r\n\r\nPackaged swab sticks are not considered sterile, thus don\u2019t put them into your sterile field.\r\n\r\nThe effectiveness of antimicrobial agents is reliant on completely drying.<\/td>\r\n<\/tr>\r\n
Stabilizing devices\u2014sutures, skin closure strips, or a securement device\u2014these devices must be sterile.\r\n
    \r\n \t
  • Change q7 days.<\/li>\r\n \t
  • Do not occlude the insertion site with SteriStrips.<\/li>\r\n \t
  • Label the dressing with the date of dressing change.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Prevents the catheter from moving, getting damaged, or occluding.\r\n\r\nPrevent microbes from transferring onto the insertion site and skin.<\/td>\r\n<\/tr>\r\n
For central lines or midlines, measure external length of the catheter from the insertion site to where the catheter enters or attaches to the connector.<\/td>\r\nEnsure catheter tip is not migrating\r\n\r\n[caption id=\"attachment_2800\" align=\"aligncenter\" width=\"300\"]\"\" Figure 8.27 Measure external length from the insertion site to the hub. Some PICCs have a visible\u00a0 \"O\" ring on it...in which case measure from the insertion site to the \"O\" ring[\/caption]<\/td>\r\n<\/tr>\r\n
Topical dressing should be centred\u00a0over the securement device.<\/td>\r\nProvides maximum coverage and helps keep the securement device securely in place.\r\n\r\nMeasure external length.<\/td>\r\n<\/tr>\r\n
Data sources: Interior Health, 2012; RNAO, 2005\/2008<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nReview the steps in Checklist 73 for changing an IV site dressing with no additional securement device.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 73 Changing an IV Site Dressing\u2014No Additional Securement Devices<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:\u00a0<\/span><\/h5>\r\n
    \r\n \t
  • Always follow the guidelines of the agency when performing this skill<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Perform hand hygiene, perform point of care risk assessment, and collect supplies.<\/td>\r\nYou will need a semi-transparent dressing, alcohol swabs, CHG swabs \u00d73 (2% chlorhexidine \/ 70% isopropyl alcohol), and clean gloves<\/td>\r\n<\/tr>\r\n
2.\u00a0Identify yourself; identify the patient using two identifiers; explain the procedure to the patient.<\/td>\r\nProper identification prevents errors. Explaining the procedure educates the patient and allows patient to ask questions.<\/td>\r\n<\/tr>\r\n
3. Sanitize working surface<\/td>\r\nReduces microorganisms and risk of transmission.<\/td>\r\n<\/tr>\r\n
4. Perform hand hygiene. Open up packages for easy access and place close by.\u00a0Donne non-sterile gloves.<\/td>\r\nPreparing packages allows for easy access.\u00a0Gloves are necessary because of risk of BBF exposure.<\/td>\r\n<\/tr>\r\n
5. Remove transparent dressing:\r\n
    \r\n \t
  • Stabilize the IV cannula.<\/li>\r\n \t
  • Loosen one edge of transparent dressing toward the IV site by stretching the dressing in the direction of loosened edge.<\/li>\r\n \t
  • Loosen the other edge of the dressing and repeat previous step.<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\r\n\r\n[caption id=\"attachment_6191\" align=\"aligncenter\" width=\"186\"]\"Removing<\/a> Removing transparent dressing[\/caption]<\/td>\r\n<\/tr>\r\n
6.\u00a0With non-dominant hand stabilizing the catheter, use the dominant hand to hold a CHG swab.<\/td>\r\nPVAD-short cannulas are rarely secured with a suture.\r\n\r\nUsing swabs allows no touch technique while cleaning the site and surrounding skin.\r\n\r\nIf allergy to CHG, consult agency policy.<\/td>\r\n<\/tr>\r\n
7. Use multi-directional friction to clean the site including surrounding skin to area beyond the size of the dressing. Allow skin to dry.<\/td>\r\nMulti-directional friction reduces microorganisms. Cleaning\u00a0 beyond the size of the dressing reduces microorganisms under the dressing thus reducing risk of infection.\r\n\r\nThe antiseptic must be dry for it to have antiseptic properties and to allow the dressing to adhere to the skin.<\/td>\r\n<\/tr>\r\n
8. Apply TSM dressing with insertion site approximately in the centre of the window. Use additional tape to ensure security and include date and time<\/td>\r\nTSM dressings allow observation of site, skin breathability.<\/td>\r\n<\/tr>\r\n
9. Ensure IV remains patent. Assess IV system.<\/td>\r\nOngoing assessment ensures proper functioning. During dressing change, position of cannula may have changed and may affect patency.<\/td>\r\n<\/tr>\r\n
10. Discard supplies, remove gloves, and perform hand hygiene.<\/td>\r\nThese steps prevent the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
11. Document procedure as per agency policy.<\/td>\r\nDocument date, time, condition of IV site, and type of dressing applied.\r\n\r\nNote<\/strong>: Some agencies require the cannula size, vein location and external length to be documented.<\/td>\r\n<\/tr>\r\n
Data sources: Interior Health, 2012; Perry et al., 2018; Phillips, 2005<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n
Watch the following video\u00a0PVAD-Short Dressing Change <\/em><\/a>by Ren\u00e9e Anderson and Wendy McKenzie (2018) of Thompson Rivers University School of Nursing.<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 74: Changing an IV Site Dressing Involving a Securement Device<\/h3>\r\n[caption id=\"attachment_1945\" align=\"aligncenter\" width=\"300\"]\"\" Figure 8.28 PICC dressing with securement device[\/caption]\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:\u00a0<\/span><\/h5>\r\n
    \r\n \t
  • Always follow the guidelines of the agency when performing this skill<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Perform hand hygiene. Perform point of care risk assessment and collect supplies.<\/td>\r\nYou will need a semi-transparent dressing, alcohol swabs, CHG swabs \u00d73 (2% chlorhexidine \/ 70% isopropyl alcohol), clean gloves, sterile gloves, dressing kit, securement device, and SteriStrips.\r\n\r\nNote: some agency protocols suggest to include changing\u00a0 needleless caps at the same time dressings are changed. Check agency guidelines.<\/td>\r\n<\/tr>\r\n
2.\u00a0Identify yourself; identify the patient using two identifiers; explain the procedure to the patient. Perform point of care risk assessment.<\/td>\r\nProper identification prevents errors. Explaining the procedure educates the patient and allows patient to ask questions.<\/td>\r\n<\/tr>\r\n
3. Sanitize working surface.<\/td>\r\nReduces microorganisms and risk of transmission.<\/td>\r\n<\/tr>\r\n
4. Perform hand hygiene. Open the sterile field. Add sterile items into the field.<\/td>\r\nItems that are remaining under the dressing must be sterile.\r\n\r\nIf using CGH swabs, know if they are sterile. If not sterile, use a no touch technique to clean the site and surrounding skin.\r\n\r\n <\/td>\r\n<\/tr>\r\n
5. Donne non-sterile gloves. Remove transparent dressing and securement device:\r\n
    \r\n \t
  • Stabilize the IV cannula.<\/li>\r\n \t
  • Loosen one edge of transparent dressing toward the IV site by stretching the dressing in the direction of loosened edge.<\/li>\r\n \t
  • Loosen the other edge of the dressing and repeat previous step.<\/li>\r\n \t
  • Remove old securement device<\/li>\r\n<\/ul>\r\n<\/td>\r\n
Gloves are necessary because of risk of BBF exposure.\r\n\r\n[caption id=\"attachment_2493\" align=\"aligncenter\" width=\"230\"]\"\" Figure 8.29 Removing securement device with alcohol[\/caption]\r\n\r\n <\/td>\r\n<\/tr>\r\n
6. Place a sterile drape under the CVC ensuring the drape area that comes into contact with the CVC remains sterile.\r\n\r\nWith non-dominant hand stabilizing the catheter, use the dominant hand to hold a CHG \/ alcohol swab (assuming swab handles are not sterile).\r\n\r\n \r\n\r\n <\/td>\r\nDraping reduces risk of contaminating CVC with more microorganisms.\r\n\r\nStabilizing helps to prevent catheter migration and micro-movements at insertion site.\r\n\r\nUsing swabs allows no touch technique while cleaning the site and surrounding skin.\r\n\r\n[caption id=\"attachment_2490\" align=\"aligncenter\" width=\"246\"]\"\" Figure 8.30 Stabilize the catheter. Clean site and surrounding area with multi-directional friction[\/caption]\r\n\r\nIf allergy to CHG, consult agency policy.<\/td>\r\n<\/tr>\r\n
7.\u00a0Use multi-directional friction to clean the site including surrounding skin to beyond the size of the dressing. Allow skin to dry.\r\n\r\n \r\n\r\nMeasure external length.<\/td>\r\nMulti-directional friction reduces microorganisms. Cleaning beyond the size of the dressing reduces microorganisms under the dressing, thus reducing risk of infection.\r\n\r\nAssessing external length determines if catheter migration has happened.\r\n\r\n[caption id=\"attachment_2800\" align=\"aligncenter\" width=\"300\"]\"\" Figure 8.27 Measure external length from the insertion site to the hub.[\/caption]<\/td>\r\n<\/tr>\r\n
8. Remove non sterile gloves. Perform hand hygiene. Apply sterile gloves. Situate new securement device in place.<\/td>\r\nSecurement device will remain under the dressing, thus it must be sterile.<\/td>\r\n<\/tr>\r\n
9. Apply TSM dressing with insertion site approximately in the centre of the window. Use additional tape to ensure security and include date and time<\/td>\r\nYou might want to remove your gloves for this step. Otherwise, be careful; gloves stick to the dressing.<\/td>\r\n<\/tr>\r\n
10. Ensure IV remains patent. Assess IV system.<\/span><\/td>\r\nOngoing assessment ensures proper functioning. During dressing change, position of cannula may have changed and may affect patency.<\/td>\r\n<\/tr>\r\n
11. Discard supplies, remove gloves, and perform hand hygiene.<\/td>\r\nThese steps prevent the spread of microorganisms.<\/td>\r\n<\/tr>\r\n
12. Document procedure as per agency policy.<\/td>\r\nDocument date, time, condition of cannula, appearance of IV site, and type of dressing applied.<\/td>\r\n<\/tr>\r\n
Data sources: Interior Health, 2012; Perry et al., 2018; Phillips, 2005<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n
Watch the video PICC Dressing Change<\/em><\/a> by Shari Caputo and Wendy McKenzie of Thompson Rivers University School of Nursing (2018).<\/div>\r\n<\/div>\r\n
\r\n

Critical Thinking Exercises<\/h3>\r\n
    \r\n \t
  1. When are sterile gloves required during a CVC dressing change?<\/li>\r\n \t
  2. Why does the securement device for a CVC have to be sterile?<\/li>\r\n<\/ol>\r\n<\/div>\r\n

    Attributions<\/h2>\r\nFigure 8.27.\u00a0Oml\u00e4ggning av PICC\u00a0[Conversion of PICC]<\/a>\u00a0(modified) by Nurseirie<\/a> is used under a\u00a0CC BY-SA 3.0<\/span><\/span><\/a>\u00a0unported license.\r\n\r\nFigure 8.28. PICC dressing securement device by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.29 Remove securement device by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.30 Stabilize catheter by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.","rendered":"

    IV site dressings are intended to stop the introduction of microorganisms at the IV insertion site, which can lead to blood infection, and to help to stabilize IVs to prevent micro-movements, which can lead to phlebitis. Some principles of IV site dressing changes are:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Table 8.12 Principles of IV Site Dressing Changes<\/h3>\n<\/td>\n<\/tr>\n

    Aseptic techniques must be maintained while doing dressing change.<\/p>\n

    Tape or other securement devices that are used under the dressing must be sterile.<\/td>\n

    		\n
      \n
    • Preventing microorganisms into the client\u2019s vascular system = \u2193risk of infection at site \/ systemic.<\/li>\n
    • Remove old dressing with clean gloves.<\/li>\n
    • Sterile gloves or a non-touch technique to be used when taking off sterile securement strips or device.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Transparent semi-permeable (TSM) dressings.<\/p>\n

    Changed every time the site is changed and prn.<\/td>\n

    		Semi-permeable allows sites to “breathe.”<\/p>\n

    Transparency allows clear visualization of insertion site.<\/p>\n

    Dressings provide protective function to prevent catheter migration via stabilizing and protection from microorganisms.<\/p>\n

    If the patient’s skin is not intact and\/or there is allergy, consult agency guidelines for appropriate IV site dressing.<\/td>\n<\/tr>\n

    If gauze is needed under the dressing, change dressing q48 hours.<\/td>\nExcess moisture and gauze act as a reservoir for bacteria.<\/td>\n<\/tr>\n
    If excess hair needs to be removed, clip hair with scissors.<\/td>\nShaving may cause micro-abrasions, and intact skin is the body\u2019s first line of defense against bacterial migration.<\/td>\n<\/tr>\n
    When cleaning use multi-directional friction:<\/p>\n
      \n
    • Use 2% chlorhexidine \/ 70% isopropyl alcohol<\/li>\n
    • Clean beyond the size of the dressing<\/li>\n
    • Allow cleaning solution to dry (approx. 30 seconds)<\/li>\n<\/ul>\n<\/td>\n
    		Reduce the microbes at the insertion site.<\/p>\n

    Drying allows for maximum antiseptic activity.<\/p>\n

    Packaged swab sticks are not considered sterile, thus don\u2019t put them into your sterile field.<\/p>\n

    The effectiveness of antimicrobial agents is reliant on completely drying.<\/td>\n<\/tr>\n

    Stabilizing devices\u2014sutures, skin closure strips, or a securement device\u2014these devices must be sterile.<\/p>\n
      \n
    • Change q7 days.<\/li>\n
    • Do not occlude the insertion site with SteriStrips.<\/li>\n
    • Label the dressing with the date of dressing change.<\/li>\n<\/ul>\n<\/td>\n
    		Prevents the catheter from moving, getting damaged, or occluding.<\/p>\n

    Prevent microbes from transferring onto the insertion site and skin.<\/td>\n<\/tr>\n

    For central lines or midlines, measure external length of the catheter from the insertion site to where the catheter enters or attaches to the connector.<\/td>\nEnsure catheter tip is not migrating<\/p>\n
    \"\"
    Figure 8.27 Measure external length from the insertion site to the hub. Some PICCs have a visible\u00a0 “O” ring on it…in which case measure from the insertion site to the “O” ring<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    Topical dressing should be centred\u00a0over the securement device.<\/td>\nProvides maximum coverage and helps keep the securement device securely in place.<\/p>\n

    Measure external length.<\/td>\n<\/tr>\n

    Data sources: Interior Health, 2012; RNAO, 2005\/2008<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Review the steps in Checklist 73 for changing an IV site dressing with no additional securement device.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 73 Changing an IV Site Dressing\u2014No Additional Securement Devices<\/h3>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:\u00a0<\/span><\/h5>\n
      \n
    • Always follow the guidelines of the agency when performing this skill<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Perform hand hygiene, perform point of care risk assessment, and collect supplies.<\/td>\nYou will need a semi-transparent dressing, alcohol swabs, CHG swabs \u00d73 (2% chlorhexidine \/ 70% isopropyl alcohol), and clean gloves<\/td>\n<\/tr>\n
    2.\u00a0Identify yourself; identify the patient using two identifiers; explain the procedure to the patient.<\/td>\nProper identification prevents errors. Explaining the procedure educates the patient and allows patient to ask questions.<\/td>\n<\/tr>\n
    3. Sanitize working surface<\/td>\nReduces microorganisms and risk of transmission.<\/td>\n<\/tr>\n
    4. Perform hand hygiene. Open up packages for easy access and place close by.\u00a0Donne non-sterile gloves.<\/td>\nPreparing packages allows for easy access.\u00a0Gloves are necessary because of risk of BBF exposure.<\/td>\n<\/tr>\n
    5. Remove transparent dressing:<\/p>\n
      \n
    • Stabilize the IV cannula.<\/li>\n
    • Loosen one edge of transparent dressing toward the IV site by stretching the dressing in the direction of loosened edge.<\/li>\n
    • Loosen the other edge of the dressing and repeat previous step.<\/li>\n<\/ul>\n<\/td>\n
    		\n
    \"Removing<\/a>
    Removing transparent dressing<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    6.\u00a0With non-dominant hand stabilizing the catheter, use the dominant hand to hold a CHG swab.<\/td>\nPVAD-short cannulas are rarely secured with a suture.<\/p>\n

    Using swabs allows no touch technique while cleaning the site and surrounding skin.<\/p>\n

    If allergy to CHG, consult agency policy.<\/td>\n<\/tr>\n

    7. Use multi-directional friction to clean the site including surrounding skin to area beyond the size of the dressing. Allow skin to dry.<\/td>\nMulti-directional friction reduces microorganisms. Cleaning\u00a0 beyond the size of the dressing reduces microorganisms under the dressing thus reducing risk of infection.<\/p>\n

    The antiseptic must be dry for it to have antiseptic properties and to allow the dressing to adhere to the skin.<\/td>\n<\/tr>\n

    8. Apply TSM dressing with insertion site approximately in the centre of the window. Use additional tape to ensure security and include date and time<\/td>\nTSM dressings allow observation of site, skin breathability.<\/td>\n<\/tr>\n
    9. Ensure IV remains patent. Assess IV system.<\/td>\nOngoing assessment ensures proper functioning. During dressing change, position of cannula may have changed and may affect patency.<\/td>\n<\/tr>\n
    10. Discard supplies, remove gloves, and perform hand hygiene.<\/td>\nThese steps prevent the spread of microorganisms.<\/td>\n<\/tr>\n
    11. Document procedure as per agency policy.<\/td>\nDocument date, time, condition of IV site, and type of dressing applied.<\/p>\n

    Note<\/strong>: Some agencies require the cannula size, vein location and external length to be documented.<\/td>\n<\/tr>\n

    Data sources: Interior Health, 2012; Perry et al., 2018; Phillips, 2005<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    Watch the following video\u00a0PVAD-Short Dressing Change <\/em><\/a>by Ren\u00e9e Anderson and Wendy McKenzie (2018) of Thompson Rivers University School of Nursing.<\/div>\n<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 74: Changing an IV Site Dressing Involving a Securement Device<\/h3>\n
    \"\"
    Figure 8.28 PICC dressing with securement device<\/figcaption><\/figure>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n

    \n
    Safety considerations:\u00a0<\/span><\/h5>\n
      \n
    • Always follow the guidelines of the agency when performing this skill<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Perform hand hygiene. Perform point of care risk assessment and collect supplies.<\/td>\nYou will need a semi-transparent dressing, alcohol swabs, CHG swabs \u00d73 (2% chlorhexidine \/ 70% isopropyl alcohol), clean gloves, sterile gloves, dressing kit, securement device, and SteriStrips.<\/p>\n

    Note: some agency protocols suggest to include changing\u00a0 needleless caps at the same time dressings are changed. Check agency guidelines.<\/td>\n<\/tr>\n

    2.\u00a0Identify yourself; identify the patient using two identifiers; explain the procedure to the patient. Perform point of care risk assessment.<\/td>\nProper identification prevents errors. Explaining the procedure educates the patient and allows patient to ask questions.<\/td>\n<\/tr>\n
    3. Sanitize working surface.<\/td>\nReduces microorganisms and risk of transmission.<\/td>\n<\/tr>\n
    4. Perform hand hygiene. Open the sterile field. Add sterile items into the field.<\/td>\nItems that are remaining under the dressing must be sterile.<\/p>\n

    If using CGH swabs, know if they are sterile. If not sterile, use a no touch technique to clean the site and surrounding skin.<\/p>\n

     <\/td>\n<\/tr>\n

    5. Donne non-sterile gloves. Remove transparent dressing and securement device:<\/p>\n
      \n
    • Stabilize the IV cannula.<\/li>\n
    • Loosen one edge of transparent dressing toward the IV site by stretching the dressing in the direction of loosened edge.<\/li>\n
    • Loosen the other edge of the dressing and repeat previous step.<\/li>\n
    • Remove old securement device<\/li>\n<\/ul>\n<\/td>\n
    		Gloves are necessary because of risk of BBF exposure.<\/p>\n
    \"\"
    Figure 8.29 Removing securement device with alcohol<\/figcaption><\/figure>\n

     <\/td>\n<\/tr>\n

    6. Place a sterile drape under the CVC ensuring the drape area that comes into contact with the CVC remains sterile.<\/p>\n

    With non-dominant hand stabilizing the catheter, use the dominant hand to hold a CHG \/ alcohol swab (assuming swab handles are not sterile).<\/p>\n

     <\/p>\n

     <\/td>\n

    		Draping reduces risk of contaminating CVC with more microorganisms.<\/p>\n

    Stabilizing helps to prevent catheter migration and micro-movements at insertion site.<\/p>\n

    Using swabs allows no touch technique while cleaning the site and surrounding skin.<\/p>\n

    \"\"
    Figure 8.30 Stabilize the catheter. Clean site and surrounding area with multi-directional friction<\/figcaption><\/figure>\n

    If allergy to CHG, consult agency policy.<\/td>\n<\/tr>\n

    7.\u00a0Use multi-directional friction to clean the site including surrounding skin to beyond the size of the dressing. Allow skin to dry.<\/p>\n

     <\/p>\n

    Measure external length.<\/td>\n

    		Multi-directional friction reduces microorganisms. Cleaning beyond the size of the dressing reduces microorganisms under the dressing, thus reducing risk of infection.<\/p>\n

    Assessing external length determines if catheter migration has happened.<\/p>\n

    \"\"
    Figure 8.27 Measure external length from the insertion site to the hub.<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    8. Remove non sterile gloves. Perform hand hygiene. Apply sterile gloves. Situate new securement device in place.<\/td>\nSecurement device will remain under the dressing, thus it must be sterile.<\/td>\n<\/tr>\n
    9. Apply TSM dressing with insertion site approximately in the centre of the window. Use additional tape to ensure security and include date and time<\/td>\nYou might want to remove your gloves for this step. Otherwise, be careful; gloves stick to the dressing.<\/td>\n<\/tr>\n
    10. Ensure IV remains patent. Assess IV system.<\/span><\/td>\nOngoing assessment ensures proper functioning. During dressing change, position of cannula may have changed and may affect patency.<\/td>\n<\/tr>\n
    11. Discard supplies, remove gloves, and perform hand hygiene.<\/td>\nThese steps prevent the spread of microorganisms.<\/td>\n<\/tr>\n
    12. Document procedure as per agency policy.<\/td>\nDocument date, time, condition of cannula, appearance of IV site, and type of dressing applied.<\/td>\n<\/tr>\n
    Data sources: Interior Health, 2012; Perry et al., 2018; Phillips, 2005<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    Watch the video PICC Dressing Change<\/em><\/a> by Shari Caputo and Wendy McKenzie of Thompson Rivers University School of Nursing (2018).<\/div>\n<\/div>\n
    \n

    Critical Thinking Exercises<\/h3>\n
      \n
    1. When are sterile gloves required during a CVC dressing change?<\/li>\n
    2. Why does the securement device for a CVC have to be sterile?<\/li>\n<\/ol>\n<\/div>\n

      Attributions<\/h2>\n

      Figure 8.27.\u00a0Oml\u00e4ggning av PICC\u00a0[Conversion of PICC]<\/a>\u00a0(modified) by Nurseirie<\/a> is used under a\u00a0CC BY-SA 3.0<\/span><\/span><\/a>\u00a0unported license.<\/p>\n

      Figure 8.28. PICC dressing securement device by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.<\/p>\n

      Figure 8.29 Remove securement device by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.<\/p>\n

      Figure 8.30 Stabilize catheter by author\u00a0is licensed under a\u00a0CC BY-SA 4.0<\/span><\/span><\/a>\u00a0international license.<\/p>\n","protected":false},"author":397,"menu_order":10,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1798","chapter","type-chapter","status-publish","hentry"],"part":912,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1798","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":26,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1798\/revisions"}],"predecessor-version":[{"id":5155,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1798\/revisions\/5155"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/912"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1798\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=1798"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=1798"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=1798"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=1798"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}