中心静脈アクセス デバイス変更のドレッシング
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Q1: What are the different types of central venous access devices?
Central venous access devices (CVADs) include multi-lumen central venous catheters, pulmonary artery catheters, dialysis catheters, port-a-cath, and peripherally inserted central catheters (PICC). These large-bore IV catheters are introduced into central circulation, typically terminating in the superior vena cava near the right atrium. CVADs may be tunneled, inserted at one location and tunneled under skin to emerge elsewhere, or non-tunneled, inserted directly through skin into a vein.
Q2: Why is sterile technique critical when changing CVAD dressings?
Sterile technique prevents central line associated blood infections (CLABSI), a serious complication of CVADs. Because these devices access central circulation directly, any contamination during dressing changes can introduce pathogens into the bloodstream. Nursing standards mandate strict aseptic technique throughout the entire dressing change process to maintain device safety and patient protection.
Q3: How often should CVAD dressings be changed?
The Centers for Disease Control recommends changing CVAD dressings at least every 2 days for gauze dressings and at least every 7 days for transparent dressings in adult patients. For pediatric patients, nurses should use clinical judgment to determine appropriate timing, as the risk of accidental line removal during dressing changes may outweigh the benefits of frequent changes.
Q4: What is the proper technique for removing an old CVAD dressing?
Gently peel back tape anchoring the CVAD lines, then slowly peel back each corner of the dressing toward the insertion site. Hold skin near the site being pulled to ease removal and decrease tissue damage. Continue until within 2 cm of the insertion site, then grasp a bottom corner and remove by pulling toward the insertion site and outward. Hold the CVAD tubing with your non-dominant hand throughout to prevent accidental dislodgement.
Q5: How should the insertion site be cleaned before applying a new CVAD dressing?
Use a chlorhexidine wand, squeezing the wings to release fluid and pressing at the insertion site. Grasp the CVAD tubing between your pinky and ring fingers to move it during cleaning. Clean the site for at least 30 seconds using back-and-forth motions with friction, finishing by moving gently up the catheter tubing. Allow all surfaces to dry completely before applying the new dressing, which may take up to two minutes.
Q6: What supplies are needed for a CVAD dressing change?
Required supplies include sterile gloves, clean gloves, two face masks, 2% chlorhexidine wand, presoaked antimicrobial disc, alcohol swab, one-inch cloth tape, and transparent dressing. Many facilities provide CVAD dressing change kits containing these items. An extra pair of sterile gloves should be available in case of contamination, and an institutional central line anchoring device may be required. All packages must be assessed for sterility before use.
Q7: What should be documented after completing a CVAD dressing change?
Document the date, time, location, and site of the dressing change in the electronic health record. Include your assessment of the insertion site condition and how the patient tolerated the procedure. Thorough documentation ensures continuity of care and provides a record of site monitoring, which is essential for detecting early signs of infection or complications related to the central line. This documentation supports safe administration of secondary intermittent intravenous medications and other therapies delivered through the CVAD.