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Procedures

Central Venous Catheter Dressing Change

Preparation of Graft/Fistula for Cannulation

Procedure For Peritoneal Dialysis Exit Site Care

Central Venous Catheter Dressing Change

Purpose:
To provide ongoing antimicrobial care of the central venous catheter.

Supplies:
ExSept Plus solution, 1 package of sterile 2x2 gauze pads, 2 package of sterile 4x4 gauze pads, chux sheet, 2 sterile fields or sterile underpads, sterile gloves, non sterile gloves, dressing (occlusive or non occlusive according to clinic protocol), staff face shield, patient mask.

Procedure:

• Staff should wash their hands and don a face shield. Patient should don a face mask.
  
• Place underpad under the catheter. Open sterile field onto a newly cleaned surface or chux sheet.
  
• Carefully open 2x2, 4x4 gauze pads and occlusive dressing onto sterile field.
  
• Saturate 4x4 gauze pads with ample amounts of ExSept Plus Solution (at least 10 cc's).
  
• Staff should put on clean non sterile gloves.
  
• Carefully remove old dressing from the catheter site and discard.
  
• Assess exit site according to clinic protocol.
  
• Remove non sterile gloves.
  
• Staff should wash hands and put on sterile gloves before cleaning exit site.
  
• Take one of the ExSept Plus saturated 4x4 gauze pads and clean exit site starting at the center and move in a circular motion outwards to a radius of at least 2 inches from the site.
  
• Repeat with the second ExSept Plus saturated 4x4 gauze pad.
  
• Wait two minutes for site to dry.
  
• Place sterile 2x2 gauze pad over the exit site, then place the dressing taking care not to kink the catheter.

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Preparation of Graft/Fistula for Cannulation

Purpose:
To prevent infection from skin bacteria contamination during access cannulation.

Supplies:
ExSept Plus solution, 2 packages of sterile 2x2 gauze pads, chux sheet, non sterile gloves, staff face shield.

Procedure:

• Staff member should wash hands and put on a face shield.
  
• Have the patient wash the access site prior to sitting in the dialysis chair.
  
• On a clean chux sheet or under pad carefully open both packages of sterile 2x2 gauze pads keeping pads on sterile wrappers.
  
• Saturate both sets of 2x2 gauze pads with ample amounts of ExSept Plus solution (at least 10 cc's).
  
• Put on clean non sterile gloves.
  
• Take one of the ExSept Plus saturated 2x2 gauze pads and clean the venous site starting at the center and moving in a circular motion outwards to a radius of at least 2 inches covering the insertion site.
  
• Wait two minutes before cannulating.
  
• Initiate dialysis treatment as per clinic protocol.

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Procedure For Peritoneal Dialysis Exit Site Care

Purpose:
To provide ongoing antimicrobial care of the PD exit site.

Supplies:
ExSept Plus solution, sterile 4x4 gauze pads, sterile cotton swabs, chux sheet, 2 sterile fields or sterile underpads, sterile gloves, non sterile gloves, dressing (occlusive or non occlusive according to clinic protocol), staff mask, patient mask, tape.

Procedure:

• Staff should wash their hands and don a face shield. Patient should don a face mask.
  
• Staff should put on clean non sterile gloves, and assist the patient with placing a sterile underpad beneath the catheter.
  
• Open sterile field onto a newly cleaned surface or chux sheet.
  
• Carefully open 4x4 gauze pads, cotton swabs and dressing onto sterile field.
  
• Saturate 4x4 gauze pads and cotton swabs with ample amounts of ExSept Plus solution (at least 10 cc's).
  
• Assess and remove the old dressing. Note any presence of drainage or odors.
  
• Assess exit site according to clinic protocol.
  
• Remove non sterile gloves, wash hands and put on new sterile gloves.
  
• Using sterile cotton swab, remove dried blood and exudates from the exit site. Discard old swab and use new swab to repeat until exit site is clean.
  
• Take one of the ExSept Plus saturated 4x4 gauze pads and clean exit site starting at the center and moving in a circular motion outwards to a radius of at least 2 inches from the exit site. Repeat with a new ExSept Plus saturated 4x4 gauze pad until the site is clean.
  
• ExSept Plus must remain on the skin for 2 minutes before applying dressing.
  
• Carefully apply dressing according to clinic protocol.
  
• Tape as needed.

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