Clean vs Aseptic IV Starts

[danh3190]

I'm a nursing student and long time paramedic. When they taught us to start IVs way back in the '80s we were taught to prep the site with betadine/alcohol or just alcohol then we weren't allowed to touch the site except, of course, with the angiocath.

Over the last few years I've noticed a lot of ER nurses and paramedics prepping the site, putting on clean (not sterile) gloves, then feeling the vein with their gloved finger right before inserting the angiocath.

We were always taught this was a big no-no as we were recontaminating the site. Of course I realize that we'll never be surgically aseptic and that the deeper skin layers have bacteria, but we were always taught to do the best we could. When I mentioned it to fellow paramedics I get "I don't believe in asepsis" or just a snort.

Have I missed something? Is there some research that shows that a clean technique is acceptable for IV insertion?

[st4304]

...Is there some research that shows that a clean technique is acceptable for IV insertion?

I didn't take the time to look for research (sorry!), but according to the Infusion Nursing Standards of Practice to which nurses are held in the US regarding invasive line placement, only midline, arterial, central, and PICCs are required to be placed using sterile technique.

Im not sure if you are familiar with setting up a sterile field, but that requires a hat, gown, mask, sterile gloves, and sterile drapes/towels. I believe that is overkill for a simple peripheral IV start.

As far as contaminating the site with a clean, gloved finger -- if the site was cleansed with alcohol, it is considered a clean site - not sterile, so touching the skin to palpate the vein 1-2 cm above the insertion site I believe is not really doing harm. I know not everyone will agree with me, but I have worked in the ER and I know first hand that sometimes you just have to get access the cleanest way possible. Many facilities have policies that all IVs started in the field or ER must be changed within the first 24 hours after admission.

Just continue to place IVs the way you were taught. Check with your facility's infection control nurse to see if he/she is collecting data on phlebitis (with insertion) rates and be proactive.

Sherri

[Ariesbsn]

danh3190,

I am chuckling to myself thinking about the various ways I was taught to start an IV. I was taught the same way you were in nursing school (2003). Most of the nurses I work with insist on ripping the glove tip off of their palpating finger and have tried to convince me that is acceptable. It isn't. Way back in the early 1990s when I was a CNA in a small hospital was when I first learned to start IVs. I was taught to palpate often.

The way I reconciled the 2 ways was to clean my gloved, palpating finger with an alcohol wipe and then put a drop or 2 of whatever the cleaning medium is in the IV start kit on my palpating finger, and then clean my site. That way, I could use my palpating finger because it was at least as clean as the pt's arm.

[firstaiddave907]

Quick question my dad just had surgery yesterday and i saw the nurse remove the IV without any gloves on i found that to be a little odd because dont they teach the nurses to wear gloves when your doing patient care like removing an IV from a pt's arm. could it be that when the nurse went through nursing school that they didnt teach that the nurse started to tell us her story how she wnet to nursing school in 1988.

[Ariesbsn]

firstaiddave907,

The nurse should have been wearing gloves. That being said, the tape and the tegaderm stick to your gloves (just like they stick to the patient's arm hair). I keep 1 hand gloved, and one hand gloveless to peel the sticky stuff. Once everything is peeled to the point where I will be removing the whole kit and caboodle I glove the other hand and remove everything, dress the site, and apologize for the removal of the IV being worse than having your legs waxed.