4.4 Checklist: Change a CVAD Dressing and Needleless Connector

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Change a CVAD Dressing and Needleless Connector^[1],[2]

• Review the client’s medical record for information related to the central venous access device and indications.
• Determine the date of the last dressing change.
• Gather the necessary equipment:
  • Antiseptic (chlorhexidine preferred)
  • Sterile transparent semipermeable dressing (may be chlorhexidine-impregnated) or sterile 4” × 4” (10-cm × 10-cm) gauze pad
  • Sterile tape
  • Sterile drape
  • Alcohol-free skin barrier solution
  • Sterile gloves
  • Gloves
  • Masks x 2 (one for nurse and one for the client)
  • Label
  • Sterile needless connectors
  • Sterile disinfectant caps
  • Sterile, preservative-free, prefilled syringes with 10 mL 0.9% normal saline (Number of syringes required based on number of lumens of the CVAD)
  • Stabilization device, if indicated, such as a Stat Lock or Stay Fix
  • Antimicrobial patch or biopatch for placement over the insertion site
  • *Many facilities have sterile pre-packaged CVAD dressing kits that contain the necessary supplies for a CVAD dressing change. Use of pre-packaged kits is recommended when available.
• Perform hand hygiene.
• Confirm the client’s identity using at least two patient identifiers and check allergies.
• Provide privacy.
• Explain the procedure to the client and family (if appropriate) and answer any questions. Family members should also wear a mask if present in the room during the dressing change.
• Raise the bed to the appropriate working height.
• Measure the external catheter length through the intact dressing.
• Put on a mask. Instruct the client to put on a mask and turn their head opposite from the CVAD site.
• Perform hand hygiene and put on gloves.
• Assemble the supplies on a sterile field.
• Remove the existing dressing by lifting the edge of the dressing at the catheter hub and gently pulling it perpendicular to the skin toward the insertion site. Discard the dressing in an appropriate receptacle. Remove the engineered stabilization device and discard it.
• Assess the catheter-skin junction and surrounding skin. Inspect the catheter integrity.
• Remove gloves and perform hand hygiene.
• Don sterile gloves.
• Follow manufacturer’s recommendations for appropriate cleansing products, application, and dry times. Always allow the product to dry naturally without wiping, fanning, or blowing on the skin.^[3] Cleansing products are typically applied using a back-and-forth motion while moving vertically and horizontally for at least 30 seconds. Apply a skin barrier solution, engineered stabilization device, and/or chlorhexidine-impregnated sponge according to the manufacturer’s instructions.
• Apply a transparent semipermeable dressing over the catheter insertion site. Label the dressing with the date according to agency policy.
• Open the needleless connector package using sterile technique and inspect the integrity of the device. Attach the prefilled 10-mL normal saline syringe and prime the connector.
• Ensure the clamp between the connector and the catheter is closed.
• Remove the existing needleless connector. Perform a vigorous scrub of the catheter hub per facility policy. Allow it to dry completely.
• Attach the new primed needleless connector to the catheter hub and rotate to tighten.
• Unclamp the catheter and aspirate for a blood return. If blood is aspirated, slowly inject the normal saline flush into the catheter using a pulsatile flushing technique.^[4]
• Clamp the catheter and remove the syringe.
• Place a new antiseptic-impregnated sterile port cap on the needleless connector, if available.
• Dispose of used equipment in appropriate receptacles.
• Remove and discard gloves and other personal protective equipment, if worn.
• Perform hand hygiene.
• In an inpatient setting, help the client into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the client knows how to use the call light to summon assistance. To ensure the client’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.

Documentation Cues:

• Date/Time of procedure
• Condition and appearance of site, condition, and type of securement device, if used
• Measurement of catheter (if appropriate and performed)
• Number of lumens to the catheter
• Type of dressing applied with date/time
• ANTT technique and masking for the procedure were used
• Injection cap change and to which lumens and date/time of cap change
• Type of stabilization device used
• Client’s tolerance of the procedure
• Teaching provided to the patient and family (if applicable), understanding, and follow-up teaching needed
• Any unexpected outcomes, if the health care provider was notified due to any complications, what interventions were provided to the client, and the client’s response to treatment