The majority of patients that have a central line are in the ICU. The central line has 3 lines for IV access for the critically ill patient. To prevent infection of the central line, it is imperative to follow hospital protocol and report any swelling, redness or drainage from the site to the physician. There will be times that the tip of the central line may be sent for culture if the patient has a spike in fever or there is no improvement of infection (sepsis). Nurses in the ICU have taken an ACLS course that gives them protocol to follow in the event the patient experiences any changes in their heart rhythm or rate.
Always check with the facility for how often a central line dressing is to be changed. Some facilities use Chlorhexidine, which is effective on gram-positive and gram-negative bacteria, and may require the dressing change be done every 4th day or 7th day. Either case, follow protocol. Always write the date, time, and initials once the dressing has been changed. Use sterile technique when changing the dressing. The patient needs a mask on and so does the nurse. If there are any people in the room they too will need a mask on. This prevents airborne contamination. If you are a nurse and do not have ACLS certification, consider taking an ACLS course and become certified.
Nurses should always document how the patient tolerated the procedure, the integrity of the site, and ensure that the sutures are still intact. Also, note where the line is at and inspect several times throughout your shift, and inspect after turning a patient. Document which types of IV fluids are infusing in each of the lines. For example, Dopamine infusing via the distal port at 10mcg/kg/min. Always wash hands before starting the procedure. The follow is just a guideline, and once again follow the hospital’s protocol.
-Wash Hands prior to starting, and educate patient about the procedure and the relevance of wearing the mask.
-Have a table close at side with the central line dressing kit opened and ready for use.
-Place mask on patient and nurse
-Apply clean gloves and remove the old dressing carefully and discard in trash can.
-Remove the gloves and put on the sterile gloves. Inspect the skin at the site of the central line and remember to document the appearance and the mark where the line is at the site.
-Cleanse the site with the chlorhexidine as directed.
-Let the site dry. Do not blow on it or fan it with your hands.
-Place the sterile dressing over the site. If your facility uses the anti-bacterial disc, place it over the insertion site and then apply the dressing.
-Remember to write the time, date and initials.
The nurses in the ICU are always concerned with infection as the patient’s immune systems are already compromised and are unable to fight any infections of cross contamination. The majority of nurses in the ICU have been certified in ACLS by taking and successfully passing an ACLS course that gives them valuable information to intervene in heart arrhythmias, strokes or heart attacks. Remember to report any spike in temperature, or any changes in the appearance of the central line site. Tape the line securely so the patient does not pull the line out.