Chapter 8: IV Therapy
8.10 IV Site Dressing Changes
Critical Thinking Exercises: Questions, Answers, and Sources / References
- When are sterile gloves required during a CVC dressing change?
Answer: it will depend on the agency’s protocols but generally sterile gloves are used to handle sterile equipment such as anything that will remain under the CVC site dressing ie. steristrips, securement devices.
2. Why does the securement device for a CVC have to be sterile?
Answer: The securement device will remain under the sterile dressing and the dressing is only changed every 7 days thus the need for a high level of asepsis.
Sources:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Perry, A.G., Potter, P.A., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed). St. Louis, MO: Elsevier-Mosby.
- Which of the following principles must be considered when changing IV site dressings: (Select all that apply)
| Prinicple | Answer | More information |
| Sterile gloves must always be worn | Incorrect | Sterile gloves are only necessary when handling items that will remain under the sterile dressing ie. stabilization device |
| Multidirectional friction when cleaning | Correct | This reduces microorganisms more effectively than one wipe, one way |
| Use hydrogen peroxide as cleansing agent | Incorrect | Use 2% chlorhexidine / 70% Isopropyl Alcohol |
| Clean only within the confines of where the dressing will be | Incorrect | Clean beyond the size of the dressing to reduce bacteria and thus reduce risk of infection at the site |
| Measure the external length of CVCs | Correct | This is important to assess for catheter migration. If the external length has changed, consult the necessary health care provider for further direction. Placement may need to be verified with XRAY or ultrasound |
| If the IV site has a lot of hair, shave it. | Incorrect | Clipping is the recommended practice. Shaving results in microscopic cuts in the skin which increases risk of infection |
Source:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Registered Nurses’ Association of Ontario (RNAO). (2005) Nursing best practice guideline: Care and maintenance to reduce vascular access complications [Revised 2008 supplement]. http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf.
- Which principles apply to changing PICC dressings? Select all that apply
| Distractor | Answer | More information |
| Use of a transparent semi permeable | Correct | This prevents accumulation of moisture at the site to reduce risk of infection. Transparency allows visualization of the site |
| Change q7 days unless site is leaking and/ or soiled | Correct | |
| Change guaze dressings q4h | Incorrect | Guaze dressings should be changed q48hours to allow visualizaiton of the site and remove any accumulating moisture |
| Use clean technique | Incorrect | Aseptic technique is necessary to reduce risk of infection |
Source:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Registered Nurses’ Association of Ontario (RNAO). (2005) Nursing best practice guideline: Care and maintenance to reduce vascular access complications [Revised 2008 supplement]. http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf.
- Best practice guidelines suggest the following in relation to PICC site asepsis: select all that apply
| Distractor | Anser | More information |
| Use 10 % Povidone Iodine for cleaning | Incorrect | Best practice guidelines recommend 2% chlorhexidine with 70% isopropyl alcohol as a cleansing solution |
| Use 2% chlorhexidine with 70% isopropyl alcohol for cleaning | Correct | |
| Use of circular friction when cleaning | Incorrect | Best practice guidelines recommend multidirectional friction when cleaning |
| Allowing the cleansing agent to dry for at least 30 seconds | Correct | Antimicrobial action occurs when the cleaning agent is dry |
Source:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Registered Nurses’ Association of Ontario (RNAO). (2005) Nursing best practice guideline: Care and maintenance to reduce vascular access complications [Revised 2008 supplement]. http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf.
- When performing a PICC dressing change, the RN measures the external measurement and finds it is 6 cm longer than as at the previous dressing change. The nurse should:
| Distractor | Answer | More information |
| Inform the physician anticipating an XRAY to confirm position | Correct | The PICC line may have migrated away from the original position |
| Clamp the PICC and not use it until placement is confirmed | Not necessarily. | The PICC line may have migrated away from the original position but unless there are other signs of complications, is likely still safe to use |
| Question the competence of the nurse who performed the previous dressing change | Incorrect | Although you might question their competence you should consider other things like…was the PICC line secured well…did something happen to the site since the last dressing change…was the line measured correctly…is there a need for staff education. |
| Apply double securement devices | Incorrect | If used properly the securement devices plus the dressing provide stability for the PICC line |
Source:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Registered Nurses’ Association of Ontario (RNAO). (2005) Nursing best practice guideline: Care and maintenance to reduce vascular access complications [Revised 2008 supplement]. http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf.