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Zorluk: Çok zorPharmacological and Parenteral Therapies

A nurse is preparing to perform a routine central venous catheter (CVC) dressing change for a client receiving long-term parenteral nutrition. In what chronological order should the nurse perform the following steps to ensure strict aseptic technique and prevent catheter dislodgement?

  1. 1Place a surgical mask on the client and instruct them to turn their head away from the catheter site.
  2. 2Don clean gloves and remove the old dressing by pulling the edges parallel to the skin toward the insertion site.
  3. 3Remove the clean gloves, perform hand hygiene, and don a pair of sterile gloves.
  4. 4Scrub the insertion site and surrounding skin with a chlorhexidine gluconate applicator using back-and-forth friction.
  5. 5Allow the cleansed area to air-dry completely without fanning or blowing on the site.
  6. 6Apply a new sterile transparent semi-permeable dressing centered directly over the insertion site.

Cevap

The correct sequence is to first apply respiratory precautions (masking the client and turning their head), then remove the old dressing using clean gloves by pulling toward the insertion site. Following this, the nurse must transition to sterile technique by removing clean gloves, performing hand hygiene, and donning sterile gloves. The site is then scrubbed with chlorhexidine using friction, allowed to air-dry completely without fanning, and finally covered with a new sterile transparent dressing.
The central venous catheter dressing change must adhere to strict surgical asepsis to prevent central line-associated bloodstream infections (CLABSI). The sequence begins with respiratory precautions to protect the site from droplet contamination. Next, the old dressing is removed using clean gloves and pulling toward the insertion site to prevent catheter migration. After removing the contaminated dressing, the nurse must discard the clean gloves and perform hand hygiene before donning sterile gloves, marking the crucial transition from clean to sterile technique. The site is then decontaminated with chlorhexidine using mechanical friction and allowed to air-dry completely, as the drying process is required for the antiseptic to destroy cell walls of pathogens. Finally, the sterile transparent dressing is applied to seal the site.

Adım Adım Çözüm

1
Establish respiratory precautions
The client wears a mask and turns their head away from the field.
Prevents airborne and droplet contamination of the exposed CVC site from respiratory tracts.
2
Remove the existing dressing safely
Using clean gloves, the old dressing is peeled toward the catheter.
Clean gloves protect the nurse from exudate. Pulling toward the insertion site prevents accidental catheter migration or dislodgement.
3
Transition to a sterile field
Clean gloves are discarded, hand hygiene is performed, and sterile gloves are donned.
The exposed insertion site requires strict surgical asepsis for cleansing; the clean gloves used for removal are now contaminated.
4
Decontaminate the insertion site
Chlorhexidine is applied with vigorous back-and-forth friction.
Mechanical friction ensures the antiseptic penetrates the epidermis to eliminate resident skin flora.
5
Allow antimicrobial activation
The site air-dries completely on its own.
Chlorhexidine's bactericidal properties depend on the drying process. Active fanning introduces microorganisms.
6
Secure the site with a sterile barrier
A transparent semi-permeable dressing is applied over the dry site.
Seals the sterile site from environmental contaminants while allowing ongoing clinical assessment.

Anahtar Kavram

Central Venous Catheter (CVC) Infection Control and Sterile Technique
Tahmini Süre:2m 0s
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Konular

Pharmacological and Parenteral Therapies

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