CVC dressing change

[drdonna]

I'm a student nurse and I'm wondering if my class instructor's practice might be out dated. (She's been an RN for more than 40 years but I don't know when she was last in a clinical setting.)

A similar question has been asked a couple of times but the threads are at leas 4 years old, so....

In your experience, when CVC dressings are changed, do you use clean gloves or sterile gloves and do you use a face mask?

CDC guidelines for evidence-based practice says you can use clean or sterile gloves and makes no mention of a mask.

My clinical instructor said masks are not used but as far as she knows, in this area, sterile gloves are used over clean.

My textbook doesn't say one way or the other.

I know policies can vary by facility, but I just want to get an idea of what's actually happening in practice.

Thanks.

[MunoRN, RN]

There is no such thing as a "legal" standard of practice as in there being laws but personally knowing and personally being involved in legal consulting I can assure you that if something happened the determinant of what is "reasonable and prudent" is often determined by what professional organizations determine the standards to be.

I would invite you to sit in and listen to one of your board's scope of practice committees and see what they say, it can be enlightening.

The "standard of practice", aka the "standard of care" is a term for how we establish negligence in a legal sense. Some practice organizations also care their recommendations "standards of practice", although those are actually two different things.

What determines the standard of care is what you not find any "reasonable or prudent" nurse doing or believing is appropriate, so it represents a very high level of acceptance. Practice recommendations on the other hand are often meant to weigh on issues where there no overwhelmingly established support for a certain practice, thus the need for a recommendation to try and guide practice to an eventual standard of practice.

This is a generally understood concept except for some reason when it comes to things related to INS, and seems to come from a particular individual's lack of understand of the term. For instance, the INS has recommended using an "antimicrobial ointment" over a CVC puncture site when it is discontinued, although even this particular INS individual points out that it doesn't matter if it's an antimicrobial ointment or not, so would it be considered "negligence" for a nurse to follow Ms. H's advice and use a non-anti-microbial ointment? Or take their recommendation to have a patient valsalva maneuver when discontinuing a PICC, which this same INS person points out isn't based on any evidence, it's just easier than differentiating between centrally inserted lines and PICCs. Or take changing "primary intermittent" tubing every 24 hours, we did a survey of a large number of hospitals and found that less than half believe this is good practice, so again, clearly not a "standard of care" if there is less than 50% support in practice.

I am a direct care liaison for litigation system wide which often involves our union's retained malpractice firm as well and have worked on many projects in conjunction with our BON's compliance officer and have never heard it suggested, particularly in court or deposition, that the "standard of practice" is decided by practice recommendations. The standard of practice is determined solely by what the standard of practice is, practice recommendations are certainly admissible but their weight is as a recommendation, not an established standard.

[iluvivt, BSN, RN]

There is no such thing as a "legal" standard of practice as in there being laws but personally knowing and personally being involved in legal consulting I can assure you that if something happened the determinant of what is "reasonable and prudent" is often determined by what professional organizations determine the standards to be.

I would invite you to sit in and listen to one of your board's scope of practice committees and see what they say, it can be enlightening.

Exactly...Thank you !