Episode 225: Central Line Dressing Changes: Get It Right the First Time

“Really knowing these steps can save our own nursing time and save our patient’s skin from all the dressing removals. If we’re not doing these dressings as much, we’re all going to be happier,” MiKaela Olsen, DNP, APRN-CNS, AOCNS®, FAAN, clinical program director in oncology at the Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on the importance of properly changing central line dressings and recommendations in practice. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by September 16, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Episode Notes

• Complete this evaluation for free NCPD.
• Oncology Nursing Podcast episodes:
  • Episode 162: What Nurses Need to Know About Central Lines and Ports
  • Episode 218: Central Venous Catheters: Heparin Harms and Recommendations for Flushing
• ONS Voice articles:
  • In the Absence of Standard Guidelines, Here Are the Recommendations and Best Practices for Vascular Access Devices
  • Use Evidence-Based Strategies for Managing Central Venous Catheters
• Clinical Journal of Oncology Nursing articles:
  • Central Line Care: Reducing Central Line–Associated Bloodstream Infections on a Hematologic Malignancy and Stem Cell Transplant Unit
  • Central Line Care: Empowering Patients to Prevent Infection and Injury Via EPIC2
  • Central Line–Associated Bloodstream Infection Prevention: Standardizing Practice Focused on Evidence-Based Guidelines
• ONS book: Access Device Standards of Practice for Oncology Nursing
• ONS courses:
  • Complications of Vascular Access Devices and IV Therapy
  • Vascular Access Devices
• ONS videos:
  • Standard of Practice for Cleansing Access Sites
  • Standard of Practice for Topical Anesthetics Prior to Insertion of a Peripheral IV
• American Journal of Infection Control article: Implementing a Program to Standardize Central Line Maintenance
• Critical Care article: Ultrasound-Guided Central Venous Catheter Placement: A Structured Review and Recommendations for Clinical Practice
• Critical Care Medicine article: Dressing Disruption Is a Major Risk Factor for Catheter-Related Infections
• Association for Vascular Access

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From Today’s Episode

“One of the most important points at which a line can become infected is at the insertion site. So that central line dressing is of the utmost importance. We cannot ignore it and we have to inspect it frequently and teach our patients to do the same so that they don’t have an infection caused by bacteria getting into that insertion site.” Timestamp (TS) 04:28

“If we don’t get the dressing right and we don’t do a good job with it, it’s not going to be clean, dry, and intact. It’s going to come off too soon. We really want our transparent, highly moisture-permeable dressings that we put over our central line catheters to stay on and meet the guidelines to stay on for seven days, and then we need to do a dressing change. If they come off sooner and you’re having to change them more frequently, then that can increase the risk of central line–associated bloodstream infections.” TS 12:07

“It’s really important that when you are doing these dressings, you have a very simple procedure in place to validate skill for the staff, and they do the same steps every time. But it’s very important that they do all the steps and that they always make sure that they have good dry time in between every step.” TS 13:10

“Bleeding is definitely a challenge, and sometimes it’s related to the way the line was inserted, if they used a cutting mechanism at the site instead of using a dilation. Sometimes the root of the problem can be that you have to go back to the people who inserted the catheters and tell them about the downstream effects and tell them some of the techniques.” TS 20:05

“If you stack dressings on top of your transparent dressing, it can no longer breathe. And now, it is going to trap moisture under there and cause infection. How you apply each of these chemicals, the dry time—there is definitely a science behind doing a dressing change. So really knowing these steps can save our own nursing time and save our patient’s skin from all the dressing removals. If we’re not doing these dressings as much, we’re all going to be happier.” TS 29:37