sterile technique question

  1. 0
    Hello,
    Going bananas trying to figure out this answer,can't find it. It's all so new, finished core last year, start again one week from now,and I'm trying to get a head start.
    could anyone tell me which one doesnt require a sterile technique
    1. surgical wound dressing change.
    2. insertion of foley catheter
    3. changing a solution bag on an intravenous infusion.

    thanks 1fabulon
  2. 14 Comments so far...

  3. 0
    I would say #3, since inserting an IV itself is aseptic. I know both 1 and 2 require sterile technique per my instructors and my experiences and are at higher risk for infection.
  4. 0
    Think about the level of invasiveness of your interventions.

    IVF and a Foley catheter are going inside a patient's body, by-passing normal barriers to infection.

    A surgical dressing is superficial, covering a wound, but not penetrating into the body.

    Now, what are your thoughts?
  5. 0
    Quote from Jolie
    Think about the level of invasiveness of your interventions.

    IVF and a Foley catheter are going inside a patient's body, by-passing normal barriers to infection.

    A surgical dressing is superficial, covering a wound, but not penetrating into the body.

    Now, what are your thoughts?
    I would imagine a surgical wound would more than likely be penetrating into the body, no? And since you will be changing the dressing, you'll be exposing the wound. #3 indicated just changing the bag of fluids, not the IV. And from what I have been taught, peripheral IV's are not sterile, just aseptic. Please correct me if I'm wrong. Thanks!
  6. 0
    Quote from linnaete
    I would imagine a surgical wound would more than likely be penetrating into the body, no? And since you will be changing the dressing, you'll be exposing the wound. #3 indicated just changing the bag of fluids, not the IV. And from what I have been taught, peripheral IV's are not sterile, just aseptic. Please correct me if I'm wrong. Thanks!
    The wound has already been created. It was imperative to maintain sterile technique at the time of surgery to minimize the risk of introducing micro-organisms below the skin surface. When changing the dressing, you are not introducing anything thru the would or under the surrounding skin. The wound and surrounding skin (even under the dressing) are not sterile, and never were, even at the time of surgery.

    Let's leave the Foley out of our discussion. I think we all agree that must be a sterile procedure.

    When changing the IV bag, you remove the empty bag from the tubing set and replace it with a new one. Doing so requires you to "spike" the new bag with the existing tubing. If you touch the spike of the existing tubing with your hand or bed linens, you risk introducing micro-organisms into the IV tubing, contaminating the fluid with bacteria that will then be infused into the patient.

    Now again, your thoughts...
    Last edit by Jolie on Sep 6, '10
  7. 0
    [QUOTE=linnaete;4519645 And from what I have been taught, peripheral IV's are not sterile, just aseptic. Please correct me if I'm wrong. Thanks! [/QUOTE]

    This is an important concept.

    It is never possible to "sterilize" skin. To use heat or chemicals which would actually kill all micro-organisms on the skin would also destroy the skin itself. Any time we perform an invasive procedure, penetrating the skin, we do our best to clean it, but it is never really sterile.

    However, the equipment and supplies we use to penetrate the body (scalpels, IV catheters, needles, Foley catheters, etc.) must be sterile to minimize the risk of infection.

    So we cleanse the skin as thoroughly as possible prior to inserting an IV and we use only sterile equipment and supplies (IV catheters, tubing and fluids). That constitutes sterile technique, even though the skin is not sterile.
    Last edit by Jolie on Sep 6, '10
  8. 0
    Jolie does have a good point, you can't touch your IV stuff to the bed and all that. Also, with surgical wounds...it really depends on the orders you have whether or not it's to be sterile. I'm a nurse on a floor where I see a lot of post op amputees and stage III or IV ulcers...so I had a pt who dehisced, and I was doing q12h dressing changes. Now I could look about 3 inches down into her gut, and it wasn't to be sterile. Also my fresh amputee patients who require dressing changes, you do a simple wash with soap and water or normal saline depending on the doctor's order. And when you have a pt with a sacral wound, it always seems that whenever they have a BM...it finds its way into the wound. So you clean it out and do a simple wet to dry. So...your thoughts haha
  9. 0
    Doesn't sterile technique require sterile gloves and sterile field? I think I'm more confused now lol....
  10. 0
    Probably #3. When you remove the covers for the tip of the tubing and the insertion site of the IV bag, those areas will be sterile and as long as you do not touch the tip of the tubing that you are inserting into the bag, the area will be sterile.

    Foley catheters require sterile technique procedure with a two handed technique where one hand will end up sterile and the other non-sterile. The non-sterile hand will be the hand that you use to hold the labia or penis.

    As for dressing changes, you can remove a dressing with regular gloves but you must change to sterile gloves to apply the new dressing. Make sure you open all your packages ahead of time and have all your stuff ready because you cannot open those things once you put on sterile gloves. If you have to open something, you will have to change gloves.
  11. 0
    Quote from Jolie
    The wound has already been created. It was imperative to maintain sterile technique at the time of surgery to minimize the risk of introducing micro-organisms below the skin surface. When changing the dressing, you are not introducing anything thru the would or under the surrounding skin. The wound and surrounding skin (even under the dressing) are not sterile,
    Are you sure? I just learned wet-to-moist dressing changes last week, and they very definitely require sterile technique (although as you noted, the skin itself is not sterile). Is a surgical dressing a different type? That may be why I'm confused.


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