H.D. Cath Exit Site Care & Maintenance

• Conducted on

  Date

• Audited by

• Location
  Address

• Employee Name:

• Job Category:

  RN

  LVN/PN

  MA/CNA/Tech

  Other

Exit Site Care and Dressing Change

• Identifies patient following medical center policy

  Yes

  No

  N/A

• Prepares patient – explain procedure as applicable, applies face mask, ensure lines procedure. Provides patient privacy

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Wears appropriate personal protective equipment – gown, mask, bouffant cap, gloves

  Yes

  No

  N/A

• Cleans and disinfects bedside table using disinfecting wipes

  Yes

  No

  N/A

• Opens sterile drape on clean bedside table

  Yes

  No

  N/A

• Opens and arrange supplies on sterile drape

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on clean gloves

  Yes

  No

  N/A

• Removes old dressing gently starting at the distal end of the catheter towards the exit site over the dressing to check for tenderness

  Yes

  No

  N/A

• Places sterile drape under catheter limbs/ports

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on clean gloves

  Yes

  No

  N/A

• Assesses exit site and catheter - for bleeding, drainage, redness and edema, warranted, use sterile gloves and palpate the exit site and surrounding areas (tunneling) to check for tenderness.

  Yes

  No

  N/A

• Applies CHG swab back & forth using friction and allows to dry. If CHG contraindicated, use povidone iodine swabs applied in circular motion from insertion site outwards, and allow to dry. <br>DO NOT wipe off, blow, or fan to speed up drying skin. <br>DO NOT touch exit site after skin antisepsis.

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on sterile gloves

  Yes

  No

  N/A

• Applies CHG-impregnated patch over the exit site correctly

  Yes

  No

  N/A

• Covers the exit site with transparent occlusive dressing correctly

  Yes

  No

  N/A

• Writes date and initials on the adhesive dressing

  Yes

  No

  N/A

• Discards used supplies in the appropriate waste containers

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

Connection to bloodlines

• Wears appropriate personal protective equipment – gown, mask, bouffant cap, gloves

  Yes

  No

  N/A

• Cleans and disinfects bedside table using disinfecting wipes

  Yes

  No

  N/A

• Opens sterile drape on clean bedside table

  Yes

  No

  N/A

• Opens and arrange supplies on sterile drape

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on clean gloves

  Yes

  No

  N/A

• Removes dressing from the catheter limbs and ports

  Yes

  No

  N/A

• Places sterile drape under catheter limbs and ports

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on clean gloves

  Yes

  No

  N/A

• Scrubs the catheter limbs including the clamps with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Removes alcohol impregnated caps (Curos/Swabcaps)

  Yes

  No

  N/A

• Scrubs the needleless connector/ports with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Attaches 10 mL syringe to each port and aspirate about 3 - 5 mL from each catheter port then discard

  Yes

  No

  N/A

• Scrubs the needleless connector/ports with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Attaches NS 10mL syringe to each needleless connector/ports and flush using “push-pull” method to check for patency, noting ease of flow or resistance

  Yes

  No

  N/A

• Scrubs the needleless connector/ports with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Connects bloodlines to needleless connector/ports aseptically

  Yes

  No

  N/A

• Starts dialysis and ensure catheter connection to bloodlines is visible at all times treatment

  Yes

  No

  N/A

• Discards used supplies in the appropriate waste containers

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

Disconnection from bloodlines

• Wears appropriate personal protective equipment – gown, mask, bouffant cap, gloves

  Yes

  No

  N/A

• Cleans and disinfects bedside table using disinfecting wipes

  Yes

  No

  N/A

• Opens sterile drape on clean bedside table

  Yes

  No

  N/A

• Opens and arrange supplies on sterile drape

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Puts on clean gloves

  Yes

  No

  N/A

• Places sterile drape under the catheter limbs

  Yes

  No

  N/A

• Scrubs the catheter limbs including the clamps with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Scrubs the needleless connector/ports with 70% alcohol or CHG swab using friction and allow to dry. *When needleless connector is due to be changed:  Uses sterile gloves to prime new needleless connectors with saline, leaving syringe attached  Scrubs the connection between the needleless connector and catheter port with 70% alcohol or CHG swab using friction & allow to dry  Removes old needleless connector & quickly replaces with new, primed, needleless connector

  Yes

  No

  N/A

• Attaches NS 10mL syringe & flush both catheter ports. *May use locking solution (e.g. heparin, t-PA, etc) following physician order

  Yes

  No

  N/A

• Discards 10 mL syringe

  Yes

  No

  N/A

• Scrubs the needleless connector/ports with 70% alcohol or CHG swab using friction and allow to dry

  Yes

  No

  N/A

• Covers needleless connector with alcohol impregnated caps

  Yes

  No

  N/A

• Wraps catheter limbs with gauze and secure with transparent occlusive dressing

  Yes

  No

  N/A

• Writes date and initials on the dressing

  Yes

  No

  N/A

• Removes gloves

  Yes

  No

  N/A

• Performs hand hygiene

  Yes

  No

  N/A

• Discards used supplies in the appropriate waste containers

  Yes

  No

  N/A

• Document assessment, exit site and catheter care in the appropriate section of the medical record

  Yes

  No

  N/A

CRITICAL THINKING

• Demonstrates/verbalizes importance of maintaining aseptic technique throughout the procedure

  Yes

  No

  N/A

• Verbalizes actions to take when signs and symptoms of vascular access are noted

  Yes

  No

  N/A