Assessment:
 specific site of CVAD
 confirmation of catheter tip location
prior to initial use
 site condition and appearance
 vital signs including heart rate and
rhythm and body temperature
 daily assessment for the need of
central venous access device
continuation
 clear labels on all lines
 fluid and/or medication infusing at the
prescribed rate
 any indicators of infection (erythema,
warmth, swelling, tenderness,
discharge)
Equipment:
1. Dressing change kit/sterile
gloves/sterile drape
2. Chlorhexidine (ChloraPrep): 3 med
checks
3. Anti-microbial patch (Biopatch) or
Chlorhexidine impregnated dressing
4. Masks for everyone in the room
5. Injection/access cap
6. If PICC line, then catheter securing
device (stat lock) shall also be required
as per patient size.
7.
Clean
gloves
Patient
Education:
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Educate patients on the signs and
symptoms of complications.
Educate patients to avoid activities
that damage the lines.
Educate pt. on care of port procedures
prior to discharge.
Educate patient/family/caregiver on
how to take care of the line: how to
change the dressing, flush the line,
what to do when the lines are blocked,
etc.
Concept Map – Connecting the Dots
Central Line Dressing Change
Description of skill:
A central line is a catheter that empties into a central vein.
Central lines are more effective than peripheral catheters for
administering large volumes of fluid, PN, and medications or
fluids that irritate veins, and for repeated and longer durations.
Proper care of insertion sites is critical for the prevention of
central line–associated bloodstream infection (CLABSI). Sterile
dressing changes are done weekly using a maintenance bundle to
prevent central line associated bloodstream infection.
Potential Complications:
Nursing Interventions:
Phlebitis: Always assess and palpate the body and
extremities.
Catheter can float in the right side of the heart: Prior to
initial use confirm the location with an X ray and receive
“okay to use” order
Occlusion or Blockage: do not force anything if it is
occluded, immediately inform the HCP.
Dysrhythmia-abnormal heart pattern indicated on the
electrocardiogram: Notify the HCP
Infection: Take vital signs and carefully look for signs and
notify the HCP.
Indications: Central lines are used when:
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There is a lack of a peripheral IV site.
Extended IV treatment is needed (going home with chemo, IV
etc.)
Vesicant or irritant solutions are to be used (chemo/PN)
Trauma and burn resuscitation
High volume flow required very quickly
Many different types of fluid required at one as in critical
care
For frequent draws (PICC lines are often used)
Evaluation:
The patient will verbalize the importance of reporting
insertion site discomfort, pain, burning, throbbing by
the end of shift. The patient will verbalize any feeling
of malaise the moment he/she feels it. The patient
will verbalize understanding care of port at home, if
discharged.
Delegation/Collaboration:
At first, a nurse should know about the hospital policy. A nurse
must collaborate with the HCP, the patient, their family and
whoever has a role in taking care of the patient. Any
abnormalities of discomfort exhibited by the patient should be
readily communicated to the HCP.
Documentation: Must be done per every shift.
Documentation:
 Catheter type
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Location
Necessity
Site assessment
Length of catheter outside of skin
Patency of all lumens
Interventions (dressing change, flushing)
Dressing assessment (sterility, integrity, tegaderm off etc.)