Today I will be performing the skill central line dressing change. First I'm going to verify the order, check the need for the procedure, and gather my supplies. My supplies I'll be gathering is a central line dressing change kit, some extra sterile gloves, extra masks, blush, and any place that I need to change on the line. Next, I'm going to knock on the door.
I'm going to perform hand hygiene. I'm going to introduce myself to the patient. Hi, my name is Brooke.
I'm going to be your nurse today. Today, we need to change to central line dressing on your line there. We're going to change the dressing.
First, I would like to ask you your name and date of birth. I'm going to compare that to her wristbands. Do you have any allergies, Patricia?
She says she has allergies to morphine and iodine. I won't be using any of those today, so that will be all right. Do you have any questions about the procedure, Patricia?
It shouldn't hurt. It should be pretty painless. We're just going to be inspecting it, putting a new dressing on. This is a sterile procedure, so at this time, I either need to check with family and provide you some privacy, have them leave. Also, during this procedure, you will be wearing a mask and I will be wearing a mask, so we do not introduce any microbes or bacteria around the area.
And I'll have you turn your head. during the procedure, the whole time of the procedure. Any questions?
Okay, now I'm going to repair the area. I'm going to lower my side rails. I'm going to raise the bed to proper working height to use proper body mechanics so I can save my back.
I'm going to position my patient into semi-fellers as... If it's comfortable and tolerable, I'm going to continue to prepare my area and grab my table. I'm going to don some gloves, clean gloves. I'm going to take these and I'm going to put these on the bed. Patient, right?
more hand hygiene and on my gloves. I also need to remove all of my jewelry, watches, because this is a sterile procedure. I also need to, if you have long hair, you need to pull your hair back as to not contaminate the field.
I'm going to place my mask on. For this procedure, just in teaching, I'm going to leave my mask off my mouth so you can hear me as I perform the skill. Next, I'm going to put the mask on my patient.
And Patricia, I'm going to have you turn your head to your left. She's going to turn her head. Now, first, before I start with my serifield, I need to inspect my sight. I need to inspect the length of my lumens. I need to inspect the arm for any drainage, inflammation, edema, or swelling.
If I need to measure the arm, I am able to do that now. I'm going to inspect what the dressing looks like. Is it coming off?
How intact is it? And note those findings. I'm also going to note that there is the microbial CHG impregnated here and that this is secured by suture.
There are other ways and other sites that you'll see and come in contact with. All right. So now I'm going to prepare, grab me a garbage can. So that is close so I can throw the old dressing away. Now I'm going to be removing the old dressing.
Now as you remove, you want to remove the bottom part first. We call this the pants on the bottom. We're going to remove that first and then discard that.
Now as you pull this dressing, as you pull the part and you pull away from the insertion site, the tegaderm will break the seal. and it will pull away. You want to hold here to secure the line as you're pulling away.
As you pull away, the Tegaderm is built with the technology that it will break the sepal and it will pull away from the patient better. All right, now I'm going to discard the old dressing. Now I'm going to change my clean gloves and discard those.
I'm going to perform hand hygiene again and now I'm going to prepare and open up my sterile field. I'm going to get my kit. I'll be opening my kit away from me.
I'm watching my one inch. We're going to turn it like, turn it, roll the lid. Ooh, all the way off. That's okay.
That was a mask that I didn't need because I already had an extra one. I'm just going to leave it on the floor. Now that my sterile kit's there, it's still in my view, I'm going to move to opening my gloves.
Now I'm going to open my sterile gloves. You're going to open up all your creases and walk along your creases here. Prevent it from folding back.
on you as you open them. Underneath here, underneath here, you're welcome to walk up and down the paper so it doesn't fold back. All right, now that they're open, I'm going to pinch first and glove one hand. Okay, now that my hands are gloved, I'm going to move to my area here.
I'm going to pinch some things out. I'm not going to use the gloves in the kit. I've decided I won't be using the drape.
You're welcome to use the drape if you will. You just spread it out with your one inch border. I'm not going to use the drape today and you can continue to pull the things out. There's something to measure in there and a few other things.
What I'm looking for is my gauze here, my 4x4 of gauze here, and then I'm looking for my chlorhexidine to clean. All right, now I'm going to come over and turn towards my patient here. I'm going to set this gauze on top of the clays to hold them secure while I'm cleaning.
All right, I'm just going to set it. I'm not going to pinch or anywhere. It's just kind of setting there so I can stay sterile with this hand.
Now I'm going to clean. So I'm going to start at the insertion site and what you want is friction or scrubbing. It's not necessary the motion. It can be side to side or circular.
But I'm going to scrub around this center area. Scrub back and forth all the way out to the outer. Work my way out.
Work my way out. Now I've worked my way out. I'm going to scrub down my tubes and get the goobers here at the end where there kind of is some where the stickers are.
I'm going to wipe those and scrub them off out. Then lastly, I'm going to lift them. Scrub under. side to side and out and then also get underneath these tubes as well all right now once that's done i'm going to let that dry and then we're going to move to placing the dressing now once it's dry do not fan it you're not blowing it let it fully dry in the kit There is also, I don't think, no, that's your disc.
You'll see what's in your kit. Each kit is individual. So here's the dressing.
I'm going to replace this dressing. It looks different. As you can see, it will be different and we'll teach you more about that in class.
It does not have the CHG piece impregnated on there. There's the securement device here and in here you'll see. this device.
For now we're just going to be placing your dressing. All right let's place the dressing. As you can see on this dressing there is a notch where your lumens will come come out of. So you're going to peel the back you're going to place the dressing up and down so that the lumens may come out the bottom.
You want the insertion site in the very center of your dressing. Going to place your dressing. You're going to push around the inside out and secure the dressing.
I'm going to peel the top piece away. Now, as you notice, do not throw this piece away. There is a piece that is your pants that you need to put back on. And there is also a piece on here to label and date.
So I'm going to put the pants on now. No. Well, all right.
We're just going to keep going. Here we go. Pants are on and that is all secured. I'm going to walk this way for just a moment so we can get lights back on.
Real life nursing, friends. This is real life. Okay, now we have finished the sterile procedure part.
We can just continue going and changing our clades now. So now I'm going to inspect my claves. I'm going to look at which one which ones that how many I have and how many I need to change.
Now I'm going to prepare to change those. I'm going to open my flush and there are many different types of claves so there's a few different ones that look a little different. Okay then I'm going to open the end that I can attach the lor-a-lock to right here.
And then attach it there. And I'm going to leave it in there for a moment inside the stirring. I'm going to look for my alcohol swabs inside my central line kit.
I'm going to open these. I'm going to... clean and disconnect the old one. I'm going to take my alcohol swab and disconnect.
Make sure that your lumen is clamped or else you're going to have blood rushing back at you. I'm going to disconnect the clave, the old clave, then I'm going to clean with the alcohol swab. I'm going to clean the center here and then work my way around it. I'm going to let that dry, no fanning, no blowing.
I'm going to take this out of the package. Make sure it is brined so you see fluid coming out of it. Okay, great. Then I'm going to take the cap off. It looks like this.
I'm going to connect it back onto it. Then you're going to unclamp. I'm going to flush your line.
Positive pressure. I'm going to check on my patient. Hi, Patricia.
How are you? Are you doing okay, Patricia? Any pain or discomfort? Nope. All right.
Central line dressing change is done. I'm going to... Reposition my patient where she's comfortable.