Clinical Skills - Central Venous Catheter Dressing Change

Hi. I'm Ellis with Level Up RN. In this video, I'll be demonstrating how to perform a central line dressing change. I'll be following the steps that we've included on our Clinical Nursing Skills deck, so if you have this deck, grab these cards, and you can follow along with me. If you don't have the deck, then you can check it out at LevelUpRn.com.

To prepare to change my patient's central line dressing, I've already done my hand hygiene and put on some just clean gloves. Then I'm going to put a mask on. And then I'm actually going to go ahead and have my patient turn their head away from the side that has the site, and I'm going to have them put a mask on as well. And he doesn't really have ears, but we're going to still pinch it over his nose right there. All right. Perfect. So I'm going to pull the gown down so I can see the site better. And my first step is simply remove the old dressing. So without pulling on the insertion site itself, because I don't want to do any damage to the insertion site, I'm going to remove this old dressing. It's awfully sticky.

[silence]

Oh boy. Let's see if I can get this off. There we go. Unfortunately, I think it melted just a little bit to my mannequin. All right. We got it off. We're heroes. And then I'm going to remove the old Biopatch. And I'll go ahead and take off my clean gloves and throw them away. And then I'm going to go ahead and set up my kit, so I simply open my kit. And my first step will, of course, be to don sterile gloves, so I grab the sterile gloves out of my kit.

[silence]

All right. So as always, I pick up my dominant hand with my nondominant hand first, and then I slide my fingers in under the cuff of my nondominant hand. All right. I'm just going to fix my thumb a little bit. And then I can slide my wrapper off into the trash can. Now in this kit, I've got things to clean the site with. I have new gauze if I need any gauze, I have a chlorhexidine scrub, and I have an antimicrobial patch that I can put on the site itself. So my first step is to simply hold this down and snap it because that impregnates this scrubby piece with the chlorhexidine part. And I'm going to hold my tubing while I scrub my patient's site, noting that I'm pressing pretty firmly. Right? I don't want to be really gentle and tender with it because I want to make sure I'm getting that friction in there. So I'm actually kind of scrubbing all around the port itself and getting the friction in there to make sure that I'm actually providing a cleaning process. I can then discard of this. I then get my microbial patch, if that's ordered, and I'm going to rethread it around the site of insertion and discard of that piece of gauze. I then get my sterile dressing. If there's a split in it, that goes over the tubing. All right. Press that down. Go ahead and take my wrapper off. And almost every dressing comes with a little sticker for you to fill out with your initials, the date, the time, and potentially the gauge of the catheter itself, so I would simply fill that out to complete my dressing change. And that's how you change a central line catheter.