MaxCares Broviac Dressing Change

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(15 mins, every 5 days after bath)

Precautions

This procedure must be kept as sterile as possible to reduce risk of infection, and Max must be kept as still as possible to reduce contamination and risk of pulling/kicking out the line.

Avoid talking, or turn your head away from the site if you must talk. Wear a face mask if you are sick.

Max will generally lay pretty still through the procedure, but you need to be ready for the moments when he is not. This works best with one person holding his legs still, and a second person keeping his hands busy and away from his broviac site, while the third person does the broviac change.

Supplies (in metal basket behind couch in Max's room; backups in dresser drawer)

  • Wash hands thoroughly and use alcohol soap and have that avail for procedure -- reapply after each step basically.
  • IV3000 dressing (orange & white packaging)
  • IV split gauze 2x2 (same as used for his g-tube site)
  • white paper tape
  • bactroban antibiotic
  • chloroprep wand (can open packaging on one wand; have another avail but unopened just in case)
  • safety scissors (white plastic handle, round tips)
  • bandnet to cover when done

Prep the IV3000 dressing w/ IV Gauze

  • Open up the IV3000 dressing packaging
  • Taking one of the 2 IV split 2x2 gauze guys out of a package and affix it to one side of the IV3000 dressing
    • peel back dressing from backing, place gauze, put back on backing
    • the end of the gauze (the part you are holding -- be sure to just touch one edge!) should line up with the end of the orange tape on the side of the dressing -- not a big deal if it is a bit off one way or the other.

Get Max Ready

  • Lay Max down, watching a video, with small toys to keep his hands occupied.

Remove Old Dressing

  • Be sure to observe current dressing to get image of what it should look like, including tension loops, taping, gauze placement.
  • peel off existing tape that goes around the broviac port end -- best to try to undo order that it is done in (see below).

Chloraprep the site

  • always move from the broviac site out, both in terms of individual strokes and overall area that you are washing.
  • be sure to get any dried crud out of the site completely using wand
  • clean around the skin in the area covered by the dressing
  • then clean the line, being sure to rotate the line to get all sides, moving from the site up the line all the way to the base of the thicker part where the clamp is -- go 1/2" up that thicker part.
  • Wait 1 minute (or possibly a bit longer depending on how wet it is from chloroprep) for the chloraprep to dry. Do not fan the site, because this can spread bacteria to it.

Apply a little bit of antibiotic directly on the site

  • NOTE: this is not currently necessary:
  • just a dab that covers the site (see photo).

Apply the IV3000 dressing

Safety Loops
  • Form the line into 1 tension loop (note: photos are not updated with chest location -- principles are the same), which will keep any tugging on the line from pulling directly on the insertion site. The free end of the Broviac should go to the lower right of his body (left as you are looking at him), away from the ostomy and other stuff. Be sure to look at this prior to removing old dressing. Key for placement is to not make it to high on his chest, which would cause it to be visible under his clothing, but not to low either because you want plenty of room to cover the Broviac.  It does end up being somewhat visible under clothing at this point.
  • Pull side of IV3000 dressing with gauze attached from backing and place on the lower/inner thigh portion of the broviac, with broviac entry site centered and just above the edge of the gauze. This part should cover one side of the broviac loop.
Dressing application
  • Then peel backing off while placing dressing down as you go to your right side. The orange tape should wrap the bottom of the thick part, with the safety loop under the dressing, and just a little bit of room left for the clip.
  • This is the trickiest step, because the dressing tends to fold over onto itself and the tension loops are hard to keep in place. Hold the dressing taut by the ends.
  • Remove the backing for both of the orange tape sections and place down. You may need to fold the tape under the gauze if the alignment is not perfect. this is not a problem.

Apply Paper Tape

First Tape Loop
  • Start with the bottom edge with the thick broviac port on it.
  • First step is to wrap a piece of tape around broviac very tightly to provide primary securing of the line.
    • Place a piece of tape (roughly 4" long) under the thick part, at an angle relative to the line (maybe 30 degree angle or so) and then wrap around and pull tight (but not too tight!) so that the sticky parts are now facing down
    • place those on top of the orange tape/skin edge -- the tape should extend roughly 1/2" beyond the edge of the dressing on either side.
  • Then put another piece under the broviac, overlapping partially with the first piece (toward the "top" edge more) -- pinch it up around broviac part.
  • Then put another piece over the broviac, pinching it around the thick part so it is tight.
  • Then another under piece in the same manner as before.
  • Then finish with another over piece.

Cover with Bandnet

and you're done!!