Changing the central venous catheter dressing for children at home

Children with intestinal failure have a central venous catheter, which can be considered a lifeline. A central venous catheter is a tube that goes into a vein in the chest, ending near the heart. Parenteral nutrition is administered through this tube. A special bandage called a dressing is placed over the catheter's exit site to block germs and to keep it dry and clean. This animation aims to provide you with some general information about how to change this dressing for children at home. The advice and techniques might vary. Between clinical teams, so always refer to your own care provider for the local protocol. This animation video should not replace the extensive formal training that parents should receive from expert clinicians with experience in parenteral nutrition and its administration at home. The dressing over the catheter's exit site must be changed routinely around once or twice a week, and more often if there is fluid or air underneath it, if it is loose, or if the exit site is infected. The dressing change can also be combined with changing the catheter hub valve. First, prepare the room and yourself. Close the windows and turn off the air conditioning. Spray any surfaces and or desk space in use with disinfectant. Tie your hair back or wear a hat. Wash your hands after removing jewelry from your hands and wrists, and after cropping up your sleeves. Gather your equipment and place it on a clean surface. Then prepare your child. Explain to the child that you are going to change the dressing. Change their nappy and empty their stoma bag if needed. Ensure that a game or distraction is available. And make sure brothers and sisters are safe and won't interrupt. Wash your hands thoroughly, firstly with normal soap, and then again with hydroalcoholic solution for at least 30 seconds. Put on a surgical mask. Then unwrap two sterile gauzes and pour antiseptic solution over them. Ensure your child is positioned comfortably with his or her top off, so that the central venous catheter line and dressing are accessible. Wash your hands again or clean them with alcohol hand gel. Remove the old dressing and Steri-Strips. Steri-Strips are small pieces of tape used to keep the central venous catheter in place. Inspect the exit site for redness, swelling, leakage, fluid or movement. Clean your hands with alcohol hand gel again. Put on sterile gloves if required by the child's clinical team. Clean the skin with one of the gauzes containing antiseptic. Clean around the exit site, starting right next to the catheter and working outwards in widening circles. Now use the 2 gauze containing antiseptic to clean the central venous catheter line itself. Start at the site where the catheter exits the skin and work outwards. Allow 30 seconds for this to dry. Curl the line in a loop in the opposite direction to the way it was, keeping the catheter in place using Steri-Strips on the skin. Place the sterile dressing over the exit site. Make sure that at least 1 centimeter of the thicker part of the line is underneath the dressing. Secure the catheter line with a band-aid or brassiere. Then wash your hands and dress your child. The central venous catheter dressing has now been changed.