What is required for dressing change at the IV site?

Infection at an IV insertion site can lead to serious complications, with research from the Centers for Disease Control and Prevention highlighting the importance of proper procedure. Therefore, understanding exactly what is required for dressing change at the IV site is not just a best practice, but a critical component of patient safety.

Quick Summary

Successfully changing an IV site dressing requires a set of sterile supplies, including a transparent dressing, antiseptic, and sterile gloves, and strict adherence to aseptic technique to maintain sterility and prevent infection. Proper preparation and assessment are also crucial for a safe procedure.

Key Points

• Sterile Technique: Always use sterile gloves and a mask to prevent introducing bacteria to the IV site during a dressing change.

• Gather Supplies: Ensure all necessary equipment, including antiseptic applicators, a new dressing, and sterile gloves, is assembled before beginning.

• Clean Thoroughly: Scrub the insertion site and surrounding skin with antiseptic for at least 30 seconds and allow it to air-dry completely.

• Assess the Site: Carefully inspect the IV insertion site for any signs of infection, such as redness, swelling, or drainage, before and after the change.

• Label the Dressing: Accurately label the new dressing with the date, time, and initials to comply with safety protocols.

• Dispose Properly: Discard all used materials in a biohazard bag to maintain a clean environment and prevent cross-contamination.

The Importance of Aseptic Technique

Maintaining a sterile environment during an intravenous (IV) site dressing change is the most crucial step for preventing catheter-related bloodstream infections. Aseptic, or sterile, technique is a set of practices performed to prevent contamination and is fundamental to safe IV care. It is imperative to follow each step meticulously to protect the patient from harmful bacteria entering the bloodstream through the insertion site. This includes proper hand hygiene, using sterile equipment, and meticulous site preparation before applying the new dressing.

Assembling Your IV Dressing Change Kit

Before starting the procedure, gather all necessary supplies to ensure a smooth and sterile process. Rushing to find an item mid-procedure can increase the risk of contamination. A standard, pre-packaged IV dressing change kit is often used, but if not available, the components must be assembled individually.

Key Supplies Breakdown

• Sterile Gloves: These create a sterile barrier between your hands and the insertion site during the critical phases of cleaning and applying the new dressing.
• Face Mask: Worn by the person performing the dressing change (and sometimes the patient) to prevent breathing or talking directly over the sterile field, minimizing airborne contamination.
• Antiseptic Solution: A single-use applicator containing 2% chlorhexidine gluconate and 70% isopropyl alcohol is the standard for cleaning the site. For patients with sensitivities, alternatives like povidone-iodine may be used.
• Transparent IV Dressing: This allows for continuous visual inspection of the site without removing the dressing. Examples include Tegaderm or similar products.
• Antimicrobial Patch (e.g., Biopatch): Some protocols call for a special patch placed around the catheter to provide additional infection protection.
• Gauze Pads and Medical Tape: Required for certain types of dressings or to absorb any bleeding after removal of the old dressing.
• Adhesive Remover Wipes: Useful for gently loosening stubborn dressings and reducing skin trauma, though not always necessary.
• Moisture-Resistant Absorbent Pad: Placed under the patient's arm to catch any spills and keep the area dry.
• Biohazard Disposal Bag: For the safe and immediate disposal of the old dressing and used supplies.

Step-by-Step Procedure for a Dressing Change

This procedure must only be performed by a trained and qualified healthcare provider or under strict medical guidance. Patient privacy and comfort should always be a priority.

Preparing the Environment and Patient

1. Introduce yourself and verify the patient's identity using two identifiers, such as name and date of birth.
2. Explain the procedure to the patient and obtain consent. Instruct them to keep the limb still during the process.
3. Ensure the work area is clean and organized. Place the moisture-resistant pad beneath the IV site.
4. Perform thorough hand hygiene and don a face mask.
5. Put on clean gloves to begin removing the old dressing.

Removing the Old Dressing

1. Hold the IV catheter securely at the hub with one hand to prevent dislodgement.
2. Gently peel the old dressing off, pulling it perpendicular to the skin and toward the insertion site.
3. Carefully remove any adhesive tape or other securement devices. If the dressing is difficult to remove, use an adhesive remover wipe.
4. Immediately discard the old dressing and clean gloves into the biohazard bag.

Cleaning the Site

1. Perform hand hygiene again and put on sterile gloves.
2. Inspect the IV insertion site for any signs of infection, such as redness, swelling, warmth, or drainage. Palpate gently for tenderness.
3. Use the sterile antiseptic applicator to clean the area. Clean the skin with a back-and-forth motion for at least 30 seconds, ensuring you clean the entire area that will be covered by the new dressing.
4. Allow the antiseptic to air-dry completely. Do not blow or fan the area, as this can introduce contaminants.

Applying the New Dressing

1. If using, place the antimicrobial patch over the catheter insertion site according to manufacturer instructions.
2. Apply the new transparent dressing, ensuring it covers the site completely and that the edges adhere well to the skin. Do not stretch the dressing during application.
3. Secure any catheter hub or tubing with a securement device or additional sterile tape as needed.
4. Label the new dressing with the date, time, and your initials. This is a critical step for adhering to dressing change protocols.

Comparison of Dressing Types

Dressing Type	Recommended Frequency	Advantages	Disadvantages
Transparent Film	Every 7 days (or sooner if soiled)	Allows visual inspection, waterproof, comfortable	Can cause skin irritation if not removed properly
Gauze	Every 2 days (or sooner if soiled)	Absorbent, allows for breathability, useful for draining sites	Opaque (requires removal for inspection), less secure, less comfortable
Antimicrobial	As specified by manufacturer/protocol	Provides extra layer of infection protection	Higher cost, can cause skin irritation in some individuals

Recognizing Signs of Complications

After a dressing change, patients should be monitored for potential complications. Signs of phlebitis (vein inflammation), infiltration (fluid leaking into surrounding tissue), and infection can include:

• Redness or warmth around the site
• Swelling or puffiness
• Pain or tenderness
• Fever or chills
• Pus or cloudy drainage

Reporting these symptoms to a healthcare provider promptly is essential for preventing more serious health issues. Accurate and consistent documentation of the dressing change procedure, including the site's condition, is also required by many healthcare protocols. For reliable information on patient safety and infection control, visit the Agency for Healthcare Research and Quality.

Conclusion: Your Role in Infection Prevention

Successfully executing what is required for dressing change at the IV site is a critical skill for any healthcare professional or trained caregiver. By adhering to the principles of aseptic technique and using the right supplies, you can significantly reduce the risk of infection and help ensure a positive outcome for the patient. Patient education and continuous assessment of the IV site are also vital for proactive care and timely intervention should a complication arise.

Frequently Asked Questions

How often does an IV site dressing change need to be done?

The frequency depends on the dressing type and hospital protocol. Typically, transparent dressings are changed every 7 days, while gauze dressings should be changed every 2 days or whenever they become soiled, damp, or loosened.

Can I change an IV site dressing at home?

Changing an IV dressing at home should only be done under the strict supervision of a healthcare provider and with proper training. Improper technique can lead to serious infection. Your provider will prescribe the necessary sterile supplies.

What should I do if the IV site looks red or swollen?

If you notice redness, swelling, increased pain, or any drainage around the IV site, contact a healthcare professional immediately. These could be signs of an infection or phlebitis that require medical attention.

What kind of antiseptic is required for a dressing change?

Most standard protocols recommend using a 2% chlorhexidine gluconate with 70% isopropyl alcohol applicator. For patients with allergies, alternatives like povidone-iodine may be used, but always follow a healthcare provider's instructions.

Is it required to wear a mask during the dressing change?

Yes, wearing a face mask is required to prevent airborne bacteria from contaminating the sterile IV insertion site during the dressing change procedure.

What is the correct way to remove an old IV dressing?

To remove an old dressing, first secure the catheter hub to prevent dislodgement. Gently peel the dressing away from the skin, starting at the edges and pulling toward the insertion site. Adhesive remover wipes can be used for stubborn dressings.

What is the role of an antimicrobial patch in an IV dressing change?

Antimicrobial patches, such as a Biopatch, are sometimes used to provide an additional layer of infection protection at the IV site. They are placed around the catheter at the insertion point.