I&D...sterile procedure?

[deefizzle]

I work for an urgent care facility and cannot locate an exact policy on this scenario. Patient comes in with cyst, doctor performs I&D for culture. I&D tray is set up using sterile technique. Sterile field, all instruments are sterile from autoclaver. Doc says he does not need sterile gloves because "this isn't a sterile procedure." I'm a little skeptical of this practice. Can someone with more experience please give me their opinion? Thanks

[BostonFNP, APRN]

I do I&D's as a clean procedure. I do not culture or script abx unless there is a complication.

[psu_213, BSN, RN]

Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.

I don't have time right now to research it, so I can only offer anecdotal "evidence." We had a male in his late teens who had an abscess in a sensitive area. Surgery was called to I&D it. After the procedure the ER doc asked the surgeon "what antibiotic should I discharge him on?" Surgeon replied "I just drained the abscess. Why would he need antibiotics?" No culture was sent. In the absence of cellulitis, I see almost no one from the ER sent home with ABX (or having had a C&S done) with an abscess I&D.

FWIW, the surgeon did use sterile technique.

[BuckyBadgerRN, ASN, RN]

But he then touches your sterile tray with exam gloves. Completely voids the intent of sterile technique. I hope your MD is receptive to your education!!

I should clarify just so I'm not making him sound worse than he is...he does wear gloves, just not sterile ones.

[BCgradnurse, MSN, RN, NP]

I use a disposable scalpel, which is sterile. I only touch the handle and never touch the site after it's cleaned. The sterile blade is the only thing that touches the abscess.

[BostonFNP, APRN]

I use a disposable scalpel, which is sterile. I only touch the handle and never touch the site after it's cleaned. The sterile blade is the only thing that touches the abscess.

Same. Alcohol prep, local anesthesia, povidone-iodine prep, drape, disposable scalpel, and clean gloves. Once the abscess is opened its non-sterile anyways.

[feelix, RN]

This should be an incident report. Don't let doc get away with it. He is supposed to know more than you do.

[BrihtneeY]

Not sterile

[Anna Flaxis, BSN, RN]

This should be an incident report. Don't let doc get away with it. He is supposed to know more than you do.

He does know more than you do, and I&D is not a sterile procedure.

[Anna Flaxis, BSN, RN]

Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.

Everybody is somebody's kid. Doesn't change anything.

[BostonFNP, APRN]

This should be an incident report. Don't let doc get away with it. He is supposed to know more than you do.

Absolutely file an incident report! See what the response is...

[MaxAttack, BSN, RN]

Yes, file an incident report for correctly doing a procedure.

I could understand if the doctor licked the blade first, but that doesn't appear to be the case. I think sometimes we as nurses forget that we also don't know everything, and sometimes should defer our knowledge to the people who were formally trained for years of their life in what they're doing.

[gonzo1, ASN, RN]

The only place you can guarantee sterility is in an operating suite. That said, I encourage the doctors to use sterile gloves etc because it never hurts to be cautious. They rarely say no.