A client receives intermittent TPN therapy through a central line on the right upper extremity. While the infusion is disconnected, the nurse is preparing to change the client's peripherally inserted central catheter. Which of the following instructions does the nurse include to prepare the client for the procedure? Select all that apply.

 

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Correct

- You will need to turn your head to the left during the dressing change

- Keep your arm at rest below the level of your heart

- Place your right arm over your chest

- Remain in high-Fowler's position during the dressing change

- To assist me, you can hand me the dressing once it is opened

Rationale

-"You will need to turn your head to the left during the dressing change" and "Keep your arm at rest below the level of your heart" are correct. Changing the dressing on a central line must be done using sterile technique. The patient can be instructed to ensure the procedure remains sterile, including having the patient turn their head to the opposite side of the catheter, and keeping the arm below the level of the heart to avoid air entering the bloodstream.

-"Place your right arm over your chest" and "Remain in high-Fowler's position during the dressing change" are incorrect because the catheter site would be above the level of the heart, which is contraindicated.

-"To assist me, you can hand me the dressing once it is opened" is incorrect because in order for the supplies to remain sterile, they must be placed in a sterile field until used. If the patient is holding the dressing, it would be considered contaminated.

References:
Best practices: Evidence-based nursing procedures (2nd ed.). (2007). Philadelphia: Lippincott Williams & Wilkins

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Question ID - 16088

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