I&D...sterile procedure?

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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

Specializes in Adult Internal Medicine.
At least we don't introduce other bacteria. Especially if you need to culture it. I don't know, like I said, I was taught that it is a sterile procedure.

You must know better than me.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I've assisted the physicians with the culture, and it is indeed a sterile procedure. Otherwise they wouldn't have special kits for it.

I've been an ED RN for 8 years. Just because there is a kit doesn't mean it's a sterile procedure. We have lots of kits — IV kits, suture removal, etc., that aren't for sterile procedures.

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Specializes in Adult MICU/SICU.
First, I sincerely hope your BFF recovers fully and has her arrhythmia issues resolved.

However, there is more than just a slight difference between her situation and a routine I&D. With implanting a sterile device into a sterile space, of course it needs to be done with strict sterile technique. When draining a collection of pus, the area over the abscess should be cleaned and sterile instruments (i.e, scalpel) should be used, but any sterility is lost the moment the abscess is opened.

That's real nice of you to say - I hope she does too. It's been a rough couple of weeks.

I understand device implantation -vs- an I&D are completely different procedures - as someone else's comparison to differing fruit varieties, and I do realize this.

The point I was trying to make was in light of my friend's very recent fiasco I am coming down on the side favoring a sterile procedure -vs- a clean procedure (if I had a choice, and it was me or my own child). My own recent experiences color my point of view, this I realize too.

Who knows, last month my decision may have been different, but with this so fresh in my mind that is how I feel today.

Let's not lose sight of the fact this is all hypothetical conjecture anyway, a discussion - after all we're not about the do an I&D and are trying to agree on how it will be performed.

There are a lot of good points discussed here - even if I favor one way over another doesn't mean I discount anyone else's beliefs or ideas.

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You must know better than me.

I am not the only one having a different opinion than you, in this thread. Why the snark?

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Specializes in Research & Critical Care.

Abscess Incision and Drainage, New England Journal of Medicine

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.569.6291&rep=rep1&type=pdf

"Although strictsterile technique may not always be necessary for incision of an already infectedskin site, in this era of antibiotic resistance it is reasonable to use sterile proceduresfor abscess drainage whenever possible"

"Subsequent treatment with antibiotics is not required after most successful incisionand drainage procedures performed in healthy patients"

Recommended, not necessary. I learned something today. Thank you, Google.

/thread

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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.

What?? No blade-licking??!!? You just spoiled all my fun! :roflmao:

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Comparing imbedded hardware closed with sutures to an I&D of an encapsulated abscess that is left open to drain is apples and oranges.

Please tell me she got a lawyer after this educated-for-years doctor and reported him to the licensing Board. Not only did his attitude stink, but his technique. Your friend needs a new doctor and should be compensated for her suffering. He caused her real harm.

She will be protecting the public by going after this jerk.

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Specializes in Adult MICU/SICU.

Ladies - nice debate. Good ideas on both sides, and many intelligent thoughts. A bit heated at times, but I enjoyed hearing everyone's thoughts.

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I've been an ED RN for 8 years. Just because there is a kit doesn't mean it's a sterile procedure. We have lots of kits — IV kits, suture removal, etc., that aren't for sterile procedures.

It does mean it is , when you are given sterile gloves and told it's a sterile procedure. Assisted several times in taking cultures and never ones seen the docs/PAs use clean gloves.

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Specializes in Adult MICU/SICU.
Please tell me she got a lawyer after this educated-for-years doctor and reported him to the licensing Board. Not only did his attitude stink, but his technique. Your friend needs a new doctor and should be compensated for her suffering. He caused her real harm.

She will be protecting the public by going after this jerk.

As a matter of fact, her PCP is encouraging this idea. Medical records are being requested. She has only been home

You'd think he would have at least listened to her concerns - she's a seasoned MSN RN with more than 35 years of experience under her belt. She is wicked smart too. I have a lot of respect for her knowledge and intelligence.

As nurses we may not receive the same education an MD gets, but that didn't mean she still couldn't spot trouble coming down the pike - fast, straight for her. It was a procedure that was supposed to have very little risks involved. And no, not an I&D.

I had a nursing instructor years ago who told us patients will forgive a lot of mistakes if you were nice to them (his opinion). There's a lot to be said in that statement, and for the most part I've discovered he was correct.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
It does mean it is , when you are given sterile gloves and told it's a sterile procedure. Assisted several times in taking cultures and never ones seen the docs/PAs use clean gloves.

Depending on the overall health of the patient and your location (in the OR, for example), it may be done using sterile technique. But in many situations, using techniques described by the NPs who responded in this thread and who perform this procedure, clean technique is used and is fine as long as it is done correctly. To be fair, I have worked in the ED with a former cardiothoracic surgeon who is of advanced age (but still awesome!!) who does everything sterile, out of habit. Do you have access to UpToDate or a similar reference database?

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The incision had dehisced, the device nearly extruded itself, and she started oozing yellow purulent drainage from the site. She had a pocket of foul smelling pus surrounding the device after less than a week S/P insertion that smelled like an exhumed coffin. She became septic - her blood cultures were positive for staph. Oh, did I mention the culture of the incision site came back positive for MRSA?

She just came home yesterday from a 5 day hospital stay with a PICC line and vanco infusions (which look pretty cool - like small balls).

Nobody touched on it yet but MRSA colonization on skin is extremely common. In fact we stopped swabbing nares to test for MRSA because it is A: extremely common, and B: usually has no significant impact on patient outcomes. I'm not saying MRSA doesn't cause issues, because it does, but simply testing positive for it may or may not have clinical significance.

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