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Teaching central line care: A combo method
Parents learn by observation and demonstration
Educating parents on the care required when their child is discharged with a central line is probably an eight in complexity on a rating scale of one to 10, says Winnie Kittiko, RN, BSN, MS, a clinical educator at the AFLAC Cancer Center at Children’s Healthcare of Atlanta.
The most important lesson they learn is changing the dressing. It is a clean procedure and parents know that because the central line goes into their child’s bloodstream, the risk of infection is greater. Parents also must learn how to flush the lines to keep them from clotting, she says.
Children are discharged with central lines for a number of reasons. Often it is for the long-term administration of medications, such as chemotherapy. They also might need a central line for long-term antibiotics or for nutritional support.
A central line is a small tube that comes out of the skin usually in the upper chest on the right or left side. It is a single line for about five inches, depending on the size of the child, and then it splits into two catheters, says Kittiko.
To learn the steps for changing the dressing, parents first watch a video that demonstrates the procedure. They then watch a demonstration by the nurse on a mannequin named Chester. Once parents have the opportunity to observe the procedure they are asked to demonstrate back either on Chester or their child. "We like parents to practice the procedure before they go home," Kittiko adds.
To help boost parents confidence about changing the dressing on their own, they are told that they can ask for assistance from the home health nurse that works for the company that delivers the supplies for the central line care to their house. Also, they can call the clinic or hospital.
A teaching sheet provides information on when to change the dressing, which is once a week unless the dressing gets wet or dirty. It also lists the steps for the dressing change as well as the supplies they will need. "We provide hints to make it easier, like having a place to spread out all the equipment they need and how to gather it all together," says Kittiko. Often parents keep their supplies on a tray table or bedside table.
Hints on how to prepare children for a dressing change, such as distracting them by showing a video are covered on the teaching sheet as well. "In the beginning when children are learning how this has to be done, they are more anxious; but usually the parents can get into a routine with their child and although he or she may not be happy at least they will cooperate and lie still," she says.
Information on proper hand washing is included on the sheet because it is an important step in a clean procedure. Signs of an infection or problems that would warrant a call to the physician also are included.
Demonstration works best
Like the dressing changes, the method for flushing the lines is taught by demonstration. The mannequin is used to demonstrate the procedure, however the parents are able to observe the process during their child’s hospital stay as well because the process is done more often in the hospital. That’s because it is often used to administer such things as medications to the child.
"During their child’s hospital stay when we are flushing the line we explain what we are doing and then give them the opportunity to do it in the course of the daily care," says Kittiko.
The amount of time spent teaching depends on the parents. Often they have to prepare mentally to learn the task. "Sometimes parents aren’t ready to be taught when we are ready to teach them so we have to go at their pace, but there comes a point in time when they need to learn," she says.
It works best to break the information up so that parents have an opportunity to absorb it, she says. The nurse often will demonstrate the procedure on the mannequin, but there won’t be time for parents to practice, therefore they will watch the video again and demonstrate back another day. Some parents watch the video several times over the course of their child’s hospital stay. Nurses try to work at whatever pace is comfortable for the family.
"We usually tell the parents that whatever they are doing whether flushing the line or changing the dressing to try and set up a routine time, such as at night after their child’s bath or in the morning when the family first gets up," says Kittiko.
For more information about educating parents on the care of central lines, contact: