How to Change a Dressing for a Hemodialysis Catheter

Watch this video to learn how and when to change a dressing for a child with a hemodialysis catheter. You should change your child's dressing if it becomes soiled with water or blood or if it comes off at home. Keeping a clean dressing on your child will limit risk of infection. This video is also available in Spanish.


How to Change a Dressing for a Hemodialysis Catheter

Narrator: Today we're going to demonstrate a dialysis catheter dressing change. There are three reasons to change a dressing at home. If it becomes lose or begins to fall off, if it looks or feels wet, or if it's soiled or bloody.

First select a clean working surface. Avoid doing dressing line care in the bathroom; it may have other germs than other rooms. Gather the items you will need to do the dressing change.

Dressing change kit, sterile glove, clean procedure gloves, CHG Tegaderm dressing, hand sanitizer, extra mask if needed, and a sharpie.

Perform hand hygiene.

Put on mask. Mask should be worn by all people completing or observing the dressing change. Your child must wear a mask or turn his head away from the insertion site during the procedure.

Perform hand hygiene.

Open the dressing kit, touching only the outside of the wrapper or the edges of the wrapper. Open the dressing and carefully drop it into the open kit.

Perform hand hygiene.

Put on clean procedure gloves. Carefully remove your child's dressing. Support the skin and catheter with your fingers while removing the dressing. Do not put your hands near the exit site. A helpful hint: Grasp one edge of the dressing and gently pull it straight out to stretch and release the dressing. Repeat at all four corners until the entire dressing has been removed from the skin.

When the dressing is off, look at the skin for signs of infection, such as redness, drainage or swelling. Take off clean procedure gloves and throw away along with the old dressing.

Perform hand hygiene.

Time to put on sterile gloves. Open package like a book, only touching outer folded edges. Put on the first glove by grasping the cuff only. Do not contaminate by touching the exterior glove. Put on the second glove by grasping under the cuff. Do not contaminate by touching the cuff with the sterile hand. As you pull on the second glove, take extreme care not to touch the exterior glove. If necessary, after both gloves are on, adjust the fingers until the gloves fit comfortably.

At this point, you can only touch sterile surfaces.

Remove the contents from the kit and place them inside of your sterile wrapper. Pick up the ChloraPrep applicator. Hold the applicator with the sponge facing downward and gently squeeze the wings to release the solution. You can use the sterile gauze pad to secure or hold the catheter as you are cleaning. Press the sponge onto the exit site and over the catheter and scrub with a sponge using a back and forth motion for 30 seconds.

If the lines are near the armpit or groin, scrub for two minutes. Allow the ChloraPrep to dry completely.

Open the No Sting Barrier Film and apply to the skin where the outer edges of the dressing will lay. Place sterile dressing over site, leaving about one to one-and-a-half inches of dressing surrounding the site. Slowly remove paper frame while smoothing down the dressing edges.

Place V-notched tape under tubing and over edge of dressing. Remove paper backing from V-notched tape and secure the site.

Apply No Sting Barrier Film around the outer edge of the dressing to help secure it. Write the date on the dressing with a sharpie marker. An aqua guard is a plastic cover that is used to protect your child's catheter dressing and catheter from getting wet. Apply the aqua guard over your child's catheter dressing before he takes a shower or bath.

Remove paper from the edge of the aqua guard and apply firmly over the entire catheter dressing. Do not allow the aqua guard to get soaking wet. It only protects the catheter from splashing water.

Throw away the aqua guard after the shower or bath. Use a fresh aqua guard with each shower or bath. If the dressing is moist or wet after taking off the aqua guard, please change the catheter dressing immediately.

When caring for your child with a central line, you should always have a bag of emergency supplies nearby; when you're at home or when you're traveling outside the home. You should have two pairs of hemostats, Tegaderms and 4 by 4 gauze pads. If the clamp, shown here on the tube, falls off and you see blood actively coming out of the tube, clamp the tube immediately with a hemostat and call 911.

If the cap shown here falls off of the catheter tube but there's no active bleeding, clamp the tube with the hemostat and go to the nearest emergency room. If the catheter falls out and there's active bleeding at the site, fold a 4 by 4 gauze and place it over the catheter insertion site. Then place a Tegaderm over the gauze and hold pressure over the exit site and call 911.

Related Centers and Programs: Pediatric Kidney Transplant and Dialysis Program, Dialysis Unit