A nurse is caring for a patient with pneumonia who has a central venous catheter in place in the subclavian vein. The nurse needs to perform a dressing change at the site. After performing hand hygiene and removing the old dressing, which best describes the next step in this process?

 

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Correct

- Apply approved antiseptic solution to the site

- Perform hand hygiene again and don sterile gloves

- Apply topical antibiotic ointment to the insertion site

- Cover the site with a piece of sterile gauze

Rationale

"Perform hand hygiene again and don sterile gloves" is correct because after removing the old dressing and exposing the central line, aseptic technique MUST be followed to prevent the introduction of bacteria or pathogens into the patient's catheter site. When performing a dressing change, the nurse should perform hand hygiene and carefully remove the old dressing. Once the dressing is discarded, aseptic technique is followed. First, the nurse applies sterile gloves. To cleanse the site, the nurse then applies an approved antiseptic solution to the skin surrounding the catheter insertion site, such as chlorhexidine solution or a solution containing isopropyl alcohol, depending on facility policy. After the solution is dry, the nurse applies the new dressing over the site and secure the catheter.
"Apply approved antiseptic solution to the site" is incorrect because after touching the patient and discarding the old dressing, the nurse's hands are soiled. Ensuring that the nurse's hands are free of bacteria is crucial in maintaining aseptic technique with a central line.
"Apply topical antibiotic ointment to the insertion site" is incorrect because the nurse has not cleaned her hands yet. The nurse knows that to prevent infection, she must follow aseptic technique and wear sterile gloves when working with a central catheter site.
"Cover the site with a piece of sterile gauze" is incorrect because the site must be cleaned (by clean, sterile-gloved hands) before applying a dressing.

References:
O'Grady, N. P. (2011). Guidelines for the prevention of intravascular catheter-related infections, 2011 (pp. 1-83, Publication). CDC.

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