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Chapter 8. Intravenous Therapy
8.10 IV Site Dressing Changes
IV site dressings are intended to stop the introduction of microorganisms at the IV insertion site, which can lead to blood infection, and to help to stabilize IVs to prevent micro-movements, which can lead to phlebitis. Some principles of IV site dressing changes are:
Table 8.12 Principles of IV Site Dressing Changes
Aseptic techniques must be maintained while doing dressing change.
Tape or other securement devices that are used under the dressing must be sterile.
Preventing microorganisms into the client’s vascular system = ↓risk of infection at site / systemic.
Remove old dressing with clean gloves.
Sterile gloves or a non-touch technique to be used when taking off sterile securement strips or device.
Transparent semi-permeable (TSM) dressings.
Changed every time the site is changed and prn.
Semi-permeable allows sites to “breathe.”
Transparency allows clear visualization of insertion site.
Dressings provide protective function to prevent catheter migration via stabilizing and protection from microorganisms.
If the patient’s skin is not intact and/or there is allergy, consult agency guidelines for appropriate IV site dressing.
If gauze is needed under the dressing, change dressing q48 hours.
Excess moisture and gauze act as a reservoir for bacteria.
If excess hair needs to be removed, clip hair with scissors.
Shaving may cause micro-abrasions, and intact skin is the body’s first line of defense against bacterial migration.
When cleaning use multi-directional friction:
Use 2% chlorhexidine / 70% isopropyl alcohol
Clean beyond the size of the dressing
Allow cleaning solution to dry (approx. 30 seconds)
Reduce the microbes at the insertion site.
Drying allows for maximum antiseptic activity.
Packaged swab sticks are not considered sterile, thus don’t put them into your sterile field.
The effectiveness of antimicrobial agents is reliant on completely drying.
Stabilizing devices—sutures, skin closure strips, or a securement device—these devices must be sterile.
Change q7 days.
Do not occlude the insertion site with SteriStrips.
Label the dressing with the date of dressing change.
Prevents the catheter from moving, getting damaged, or occluding.
Prevent microbes from transferring onto the insertion site and skin.
For central lines or midlines, measure external length of the catheter from the insertion site to where the catheter enters or attaches to the connector.
Ensure catheter tip is not migrating
Topical dressing should be centred over the securement device.
Provides maximum coverage and helps keep the securement device securely in place.
Measure external length.
Data sources: Interior Health, 2012; RNAO, 2005/2008
Review the steps in Checklist 73 for changing an IV site dressing with no additional securement device.
Checklist 73 Changing an IV Site Dressing—No Additional Secure