Vascular Access
Performing Dressing Care for a Central Venous Access Device (CVAD)
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Take the Review Test:
Safety
- If the sutures used for initial catheter stabilization become loose or are no longer intact, use alternative stabilization measures, including a stabilization device.
- Follow the Central Line Bundle of Interventions when caring for a central venous access device (CVAD):
- Hand hygiene
- Maximal barrier precautions on insertion
- Chlorhexidine skin antisepsis
- Optimal catheter site selection, with avoidance of the femoral vein for central venous access in adult patients
- Daily review of the necessity for the line, with prompt removal of unnecessary lines
- Use sterile technique to apply a dressing to the CVAD site.
- Allow antiseptic solutions to air-dry completely, since doing so will reduce the microbial count. Drying allows time for maximum microbicidal activity of agents.
- Assess the patient for allergy to iodine, latex, and chlorhexidine.
Equipment
(Roll cursor over items to see labels)
Clean gloves
CVAD Dressing kit
Sterile gloves
Transparent antimicrobial dressing
Chlorhexidine swabs
Skin protectant
Mask
Alcohol swabs
Biohazard disposal
Steri-strips
Chlorhexidine swab
PrintableDelegation
The skill of caring for a CVAD may not be delegated to nursing assistive personnel (NAP). Delegation to licensed practical nurses (LPNs) varies according to each state’s Nurse Practice Act. Instruct NAP to report the following to you immediately:
- Dressing becomes damp or soiled
- Catheter line appears to have been pulled out farther than its original insertion position
- IV line becomes disconnected
- Patient has a fever
- Patient complains of pain at the site
- Review the procedure for helping with positioning a patient during insertion and care.
Preparation
- Assess for proper functioning of an existing CVAD before therapy, including the integrity of the catheter, the ability to flush or infuse fluid, and the ability to aspirate blood.
- Assess if any catheter lumen requires flushing or if the dressing at the CVAD site needs to be changed by referring to the medical record, the nurses’ notes, agency policy, and manufacturer-recommended guidelines for use.
- Assess the patient’s understanding of the CVAD and his or her knowledge of the purpose, care, and maintenance of the device. For long-term use, ask the patient to discuss the steps in performing the procedure, including catheter-site cleaning or dressing change.
- Assess the patient for allergy to iodine, lidocaine (Xylocaine), latex, and chlorhexidine.
Follow-up
- Determine daily, in consultation with the physician, the continued need for the CVAD.
- Be alert for the following:
- Shortness of breath
- Pain in the chest or shoulder
- Bleeding or swelling at the insertion site or in the neck
- Clot formation in the catheter
- Air embolism
- Infiltration/extravasation during infusions
- Catheter migration
- Erythema, warmth, tenderness, edema, or drainage at the insertion site
- Ensure continued occlusiveness of the dressing.
- Monitor intake and output, electrolyte values, and vital signs.
- Observe the catheter and its connection points, ensuring that they are secure and free of leaks, tears, kinks, obstructions, and cracks.
- Consult the x-ray film examination reports for catheter placement. If the catheter will remain in place after discharge, use discussion and return demonstrations of dressing changes and skin care to evaluate the ability of the patient and family caregiver to provide care and maintain the catheter. Determine the need to restrict daily activities.
Documentation
- Immediately notify the health care provider of signs and symptoms of any complications.
- Document catheter site care, including the size of the catheter, appearance of the site, the condition and type of securement device if used, and the date and time of the dressing change.
- Document in your nurses’ notes any unexpected outcomes, if you notified the health care provider with any complications, what interventions were provided to the patient, and the patient’s response to treatment.
Review Questions
1. Which statement might the nurse make to nursing assistive personnel (NAP) when caring for a patient with a dressed central venous access device (CVAD) site?
“Assess the site frequently for signs of inflammation.”- “Be sure to change the transparent dressing on the site once every 7 days.”
“Let me know immediately if the patient’s dressing becomes damp.”- “Make sure the patient knows to notify me if the site becomes painful or swollen.”
INCORRECT. No aspect of CVAD assessment may be delegated to NAP.
INCORRECT. No aspect of CVAD insertion or dressing application may be delegated to NAP.
CORRECT. The task of reporting the need for a dressing change may be delegated to NAP.
INCORRECT. No aspect of CVAD patient education may be delegated to NAP.
2. Which action would the nurse take to minimize the patient’s risk for infection when changing the dressing on a CVAD?
- Use sterile technique throughout the process.
- Apply a stabilization device if the initial sutures are no longer intact.
- Apply a mask to the patient during the procedure.
- Change the transparent dressing every 48 hours.
CORRECT. Using sterile technique throughout the dressing application will minimize the patient’s risk for infection.
INCORRECT. Applying a stabilization device will not reduce the patient’s risk for infection.
INCORRECT. A mask need not be applied to the patient when changing a CVAD.
INCORRECT. Transparent dressings are changed every 5 to 7 days and as needed.
3. How can the nurse minimize the risk of dislodging the catheter when removing a dressing?
- Lower the patient’s head during the dressing change.
- Remove the transparent dressing or tape and gauze in the direction of catheter insertion.
- Apply skin protectant while the stabilization device is off.
- Cleanse the insertion site quickly and gently in concentric circles.
INCORRECT. Positioning the patient with his or her head lower will not reduce the risk of dislodging the catheter during a dressing change.
CORRECT. The old dressing should be removed in the direction of catheter insertion.
INCORRECT. Skin protectant should be applied before placing a new catheter stabilization device. However, doing so will not reduce the risk of dislodging the catheter.
INCORRECT. The site should be cleansed using a back-and-forth motion vertically and horizontally for at least 30 seconds. However, following this technique will not reduce the risk of dislodging the catheter.
4. What will the nurse do after removing the soiled dressing from a patient’s CVAD device?
- Cleanse the site with soap and water.
- Use 2% chlorhexidine swabs to cleanse the site.
- Apply a skin protectant.
- Remove the catheter stabilization device, if present.
INCORRECT. Soap and water is not used to cleanse the site of a central venous access device.
INCORRECT. The site is cleansed after the catheter stabilization device has been removed.
INCORRECT. Skin protectant is applied after cleansing the site.
CORRECT. The nurse would remove the catheter stabilization device, if present, after removing the soiled dressing.
5. What is the most important way in which the nurse can reduce the risk for infection in a patient with a CVAD that has a gauze dressing?
- Change the dressing every 48 hours.
- Apply sterile gloves to remove the original dressing.
- Cleanse the catheter and insertion site with sterile saline.
- Label the dressing with the date and time of application and the nurse’s initials.
CORRECT. A gauze dressing on a CVAD should be changed every 48 hours and as needed. Doing so will reduce the patient’s risk for infection.
INCORRECT. It is not necessary to wear sterile gloves to remove the soiled dressing.
INCORRECT. Cleansing the site with sterile saline will not minimize the patient’s risk for infection.
INCORRECT. Labeling the dressing will not minimize the patient’s risk for infection.
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