I knew it was not a correct Technique

turnforthenurse, MSN, NP · Jan 29, 2012

Look up the policy. My hospital has a kit, though the last kit I used didn't even have a biopatch in it :banghead: So I usually just assemble my own. Kit comes with sterile gloves, mask, biopatch, chloraprep, liquid adhesive and tegaderm-like dressing. I put on the mask, tell the patient to look away and with clean gloves I remove the old dressing. Put on sterile gloves, clean it, put on a new biopatch and redress it. Date, time, initials. Dressings are good for 7 days if not visibly soiled, but that is my hospital's policy. Yours might be different.

KelRN215, BSN, RN · Jan 29, 2012

My co-worker showed me how to do a PICC Line dressing change yesterday. I knew it was an incorrect technique because I reviewed the skill in youtube before. All my co-worker did was just removed the tecoderm and replaced it with a new one then dated it. What? What would you do if you were in that situation.

Most facilities have policies on how this is done, I wouldn't rely on youtube. I would have looked up the policy PRIOR to this so that, if things were done differently, I could ask questions.

MrChicagoRN, RN · Jan 29, 2012

bit passive aggressive don't you think?

While that's a non-confrontational, passive approach, that's not even close to the definition of passive aggressive.

karamarie91 · Jan 29, 2012

I would have asked, "Oh so you don't do it this way?" innocently and see what kind of response I would have gotten. When you're new, you can get away with that without sounding aggressive or a know-it-all.

Oh and by the way, the other posters are right about procedures never really being performed how they are in Youtube videos.

sapphire18 · Jan 29, 2012

I as well would not trust YouTube, it can be helpful but never the final word (like Wikipedia). However the way your coworker changed that dsg does need to be addressed. Especially since she may be showing people how to do it that may not know that that way is wrong. Honestly though, I don't know how I would approach that situation...just wanted to get it out there that something needs to be said to her. That's a huge infection control issue. I laughed out loud at the "airing it out" comment!

tokmom, BSN, RN · Jan 29, 2012

No, but maybe she would if it was left nearby. I think it's better than writing her up or approaching someone who in return could make your life a living hell because you confronted her trying to do the right thing.

I simply suggested this because the OP seems to feel she had to 'do something' or she wouldn't have even written the post! HA!

tokmom, BSN, RN · Jan 29, 2012

The nurse would probably know who it came from or at least WANT to know who it came from. If this is the way many people are doing it on the unit maybe it would be better to bring up to the manager that it may be beneficial to the floor if everyone got a brief inservice on central line dressing changes. That way no one is singled out and everyone gets the education

I guess your nurses stations are clean and organized. Ours is a mish mash of policies sitting around among everything else. I see nurses pick them up all the time, including myself, and reading them. Our policies are always tweaked, so it's important we stay on top of them.

How do you bring it up to the manger without the OP getting in trouble? If the manager asks who the OP saw changing this dressing, what is the OP to say?

Vespertinas · Jan 30, 2012

LOL, yes ours are clean and organized.

How do you bring it up? By speaking generally. I've come to my manager on many occasions to express concerns about specific things and made it clear that I did not intend on sharing names. If the manager asked, I'd courteously reply that it wasn't about anybody in particular or simply that I did not feel comfortable sharing that information. If the manager is a decent one who understands an opportunity for staff growth versus creating a punitive environment, he/she should be able to follow through without incident.

Sometimes I step back and realize some places I've worked are on par with la-la land.

merlee · Jan 30, 2012

It should be addressed.

And as for the fenestrated drape - I love those things, keeps me from touching things that I shouldn't touch!! Ask your instructor how she keeps everything sterile!!!

tokmom, BSN, RN · Jan 30, 2012

LOL, yes ours are clean and organized.

How do you bring it up? By speaking generally. I've come to my manager on many occasions to express concerns about specific things and made it clear that I did not intend on sharing names. If the manager asked, I'd courteously reply that it wasn't about anybody in particular or simply that I did not feel comfortable sharing that information. If the manager is a decent one who understands an opportunity for staff growth versus creating a punitive environment, he/she should be able to follow through without incident.

Sometimes I step back and realize some places I've worked are on par with la-la land.

I want your station. Just the other day, I had three random policies next to my computer. The place was a mess! I digress...

I totally agree, if the manager is one that is approachable that would be a good thing. Then the OP could say something. But I still think she/he needs to tread carefully and not come across as a snitch. Is education needed? Yes, it is, but I would hate to have the OP be punished for speaking up. I guess only she knows if it is safe or not, you know?

Vespertinas · Jan 30, 2012

I want your station. Just the other day, I had three random policies next to my computer. The place was a mess! I digress...

If there's a policy or notice of any kind that our management wants us to be aware of, it gets posted on the walls and doors of popular places. Our stations may be clear but our walls are layered with different colored flyers all begging for attention. Funny thing is, after a while you stop reading them and the one time recently when I did take notice was when JCAHO was coming around and suddenly it was vividly apparent that everything was GONE!

sms847 · Jan 30, 2012

I never comment on things but this comment made me stop and say something... if you are indeed a nurse and the wrong technique is done it is your RESPONSIBILITY to educate the nurse on the proper technique. That nurse (no matter if he/she had been there a day or 20 years) put the patient at risk for a blood stream infection by not properly cleaning the site and applying a new dressing.

So if this were you, Ruby, in the situation and you chose to follow your advice and "leave your coworker alone" and the patient becomes septic from a BSI and dies...who gets to tell the family that their loved one died because you didn't have the confidence in your skills and knowledge to step up and address your coworker who didn't follow proper technique.

To anyone else reading this, have a crucila conversation with the nurse and educate on the proper technique then offer to help change it again the correct way or offer to help out their patient load for a few minutes so that they have time to go redress the PICC line appropriately.