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Nephrology Nursing JournalJanuary-February 2014 Vol. 41, No. 167Shower and No-Dressing Technique For Tunneled Central Venous Hemodialysis Catheters: A Quality Improvement InitiativeTunneled central venous cathe - ters (CVCs) have been used for some time as a vascular access for hemo dialysis. CVCs are used when optimal and more perma- nent arteriovenous hemodialysis ac - cess is either not an option or not desired by the patient. They are often not the preferred vascular access by healthcare providers due to the high associated morbidity and mortality, often related to infection. Hemo - dialysis catheters are the most com- mon cause of repeatedly high rates of hospitalization for infection in this population (United States Renal Data System USRDS, 2013). Preventing catheter-related bacteremia begins with good CVC care (Lok OGrady et al., 2011). In summary, the question as to whether a dressing is required for well-healed tunneled cuffed CVCs for hemodialysis remains unknown. Taking into consideration the risk of infection, both dry gauze and trans- parent dressings are reportedly equiv- alent. Given this lack of consensus in the current literature to guide prac- tice, the preferred dressing type may be a matter of patient preference (Gillies et al., 2003). Patient Preferences and CVC Self-Care PracticesOne could ask, “Why change the standard of care?” or rather, “Why disrupt the status quo?” From a nurs- ing standpoint, it is always a challenge to institute “best practice” and “stan- dards of care” that apply to each indi- viduals lifestyle. The traditional or conventional hemodialysis prescrip- tion is approximately 12 hours of hemo - dialysis therapy per week. Therefore, interaction with the patient may trans- late to about 15 hours of time per week while being under the care of a healthcare professional after account- ing for initiating and terminating treatment procedures and allotting time for venous stasis. That time is considerably less than the remaining 153 hours per week when patients are not under the direct care or observa- tion of a healthcare provider and are actually living their lives. Is it there-Julie Ann Lawrence, RN(EC), MScN, is a Nurse Practitioner, Kidney Care Centre, London Health Sciences Centre, London, Ontario, Canada, and an Adjunct Assistant Professor, the Arthur Labatt and Family School of Nursing, Western University, London, Ontario, Canada. Suzanne Seiler, RN, is an Access Case Manager, University Hospital, London Health Sciences Centre, London, Ontario, Canada.Barbara Wilson, RN(EC), MScN, is a Nurse Practitioner, the Adam Linton Hemodialysis Unit, Victoria Hospital, London Health Sciences Centre, and an Adjunct Assistant Professor, the Arthur Labatt and Family School of Nursing, Western University, London, Ontario, Canada. Lori Harwood, RN(EC), PhD(c), is a Nurse Practitioner, the Adam Linton Hemodialysis Unit, Victoria Hospital, London Health Sciences Centre, and an Adjunct Assistant Professor, the Arthur Labatt and Family School of Nursing, Western University, London, Ontario, Canada. Acknowledgments: The authors offer their sincere appreciation to Dr. Andrew House, Nephrologist, who through his guidance and support encouraged the “status quo” to be questioned through CQI methods. Also thanks to Andrea Pember, RN; Christine St. Roch, RN; Dr. Matthew Weir; Kari Matos, RN; Sal Treesh; and all our “Shower Champions” for facilitating efforts in the completion of this project. Nephrology Nursing JournalJanuary-February 2014 Vol. 41, No. 169fore any wonder why we struggle to maintain the standard of care while patients are independently living their lives away from the eye of a healthcare team? Ideally, CVCs should be viewed as temporary hemodialysis accesses; however, the reality is that central lines serve as a permanent hemodial- ysis access for some patient groups either due to medical reasons or patient preference. Quinan et al. (2011) have described the challenges associated with conversion of the CVC to a more permanent vascular access (i.e., Gortex graft or arteriove- nous fistula) once the patient becomes accustomed to the CVC. Axley and Rosenblum (2012) studied patient resistance to using an access other than a CVC and described strategies to identify and reduce the incidence of CVC insertion in the pre-dialysis population. Whether the result of patient choice or inability for an intra - vascular access to be surgically creat- ed, all hemodialysis teams are famil- iar with the issue of CVCs being in place for years, and with some, for a decade or more. Therefore, it is not uncommon to find patients who adapt and incorporate this into their lifestyle regimens and are showering and/or bathing with the CVCs insitu in a manner that is not consistent with maintaining dressing dryness and integrity. Despite the best education instructing patients and families on how to best care for CVCs, patient modification to these instructions is observed frequently. Patient ed