Sample NCLEX-RN Question 4
A
patient has had a central venous access device (CVAD) inserted, creating a
surgical wound. To decontaminate the wound and minimize infections, what
evidence-based management strategy for dressing application has been developed by international
organizations such as the Centers for Disease Control and Prevention?
-
Apply
Chlorhexidine gluconate (CHG) impregnated sterile dressing
-
Apply
a wet antiseptic solution directly to the skin and leave it moist when applying
the film
-
Apply
sterile normal saline
-
Apply
a non-medicated sterile dressing
Answer: A
Rationale:
- Securing a central venous catheter (CVC) with a dressing impregnated
with a medication (chlorhexidine gluconate or silver) reduces catheter-related
bloodstream infection compared with a dressing without medication. Chlorhexidine
gluconate is the preferred antiseptic solution for CVAD sites
-
It is crucial to allow an antiseptic solution to dry completely before
covering the skin to prevent a reaction due to the interaction of the wet
solution and the barrier film or adhesive agent.
-
Sterile saline or water solutions are not
antiseptic solutions. They should only be used to clean the skin of gross
contaminants prior to applying antiseptic solution. Sterile normal saline may be
considered only when a patient seems to be reacting to the antiseptic choices.
-
The use of antiseptics is associated with a significantly
lower risk of intravenous line-associated (and surgical site) infections
compared with the use of aqueous solutions.
High-Yield Core Concept:
-
Venous access devices (VADs) are strongly implicated in healthcare
acquired infections. There is high-quality evidence that
medication-impregnated dressings reduce the incidence of catheter-related
bloodstream infection relative to all other dressing types.
High-Yield Fast Fact:
-
The subclavian vein has the lowest rates of
infection compared with other CVAD sites.
Reference:
- AJN 2016;116(6):49.
- Am Fam Physician 2010;82(3):249-255.
- J Wound Ostomy Continence Nurs 2017;44(3):211-220.
- NICE Guidelines.