IV site dressing

[mtnmom]

Hello, all - I need advice from some IV gurus out there. I was trained that all IV sticks should be dressed with a sterile dressing - with Tegaderm/Opsite being preferred because the site could be easily monitored.

In the department I have worked in for a year now (Mother/Baby. occ L&D) it is very common practice to start an IV and only cover it with tape, usually plastic/Dermicel type. I am not comfortable with this because 1. the tape cant be totally sterile when it has been riding around in or on someone's uniform, 2. the tape generally starts to peel up from the edges after a few hours to a day, and 3. Many people seem to react to plastic tape. As a matter of fact, the only Tegaderms we stock are twice too big and have to be cut first. When I say something about most on the unit look at me like I have four heads!!!

Then recently someone dug up an old hospital policy stating that IV site should be covered with a band-aid, then the tape. It was placed in the communication book but hardly anyone does it that way.

What is your practice? When one is available, I find a Tegaderm and cut it. when no Tegaderm available, I use bandaid and tape. But never just tape!!! Am I wrong to be obsessing on this?

[txlucky1]

Hello, all - I need advice from some IV gurus out there. I was trained that all IV sticks should be dressed with a sterile dressing - with Tegaderm/Opsite being preferred because the site could be easily monitored.

In the department I have worked in for a year now (Mother/Baby. occ L&D) it is very common practice to start an IV and only cover it with tape, usually plastic/Dermicel type. I am not comfortable with this because 1. the tape cant be totally sterile when it has been riding around in or on someone's uniform, 2. the tape generally starts to peel up from the edges after a few hours to a day, and 3. Many people seem to react to plastic tape. As a matter of fact, the only Tegaderms we stock are twice too big and have to be cut first. When I say something about most on the unit look at me like I have four heads!!!

Then recently someone dug up an old hospital policy stating that IV site should be covered with a band-aid, then the tape. It was placed in the communication book but hardly anyone does it that way.

What is your practice? When one is available, I find a Tegaderm and cut it. when no Tegaderm available, I use bandaid and tape. But never just tape!!! Am I wrong to be obsessing on this?

I agree that this is insufficient protection. Some facilities are even applying Betadine swabs to the site before dressing, much like a central line. Perhaps this is overkill, but to the patient and the good nurse...better safe that sorry!

[Rapheal]

Any type of dressing such as guaze or a band-aid type dressing should be lifted to assess the site q shift and changed q 24 hours. The clear opsite is an excellent choice because it protects the site and you can view the site without disturbing the IV cathater. I agree with you the the opsite is the best choice. We do not use just tape or gauze dressings for IV sites. We change the dressing q 96 hours(as with the site) or sooner if needed.

[gwenith, BSN, RN]

The issue is not that the tape is not sterile to start with it is "what sort of environment does it create beneath it?

Tegaderm/Opsite have been formulated to "transpire" so that a minimal amount of fluid collects beneath and they adhere well to the skin. There is a lot of reseach out there on the best site dressings,

Check this site there is a systematic review you can reference and it is very very difficult to get a "better" or more valid source than the JBI.

http://www.joannabriggs.edu.au/pubs/best_practice.php

[TinyNurse, RN]

sterile opsite is the best choice, then tape it down with tape after the original site has been secured.,

xo Jen

[Renee' Y-Y]

We are now using biopatch + opsite. I have been a nurse for about 18 years now. About 2 years ago I took care of a patient (the only one ever in my career) that lost his right hand because of peripheral IV complications...and of course he was right-hand dominant. I think IV's are something we take for granted because they are such a routine part of our practice.

No, I don't think you are obsessing...there may not be a whole lot you can do about your co-worker's practice...but you certainly can your's. A suggestion: do an internet search on litigation r/t IV complications & post that in your communication book. Also, contact your manager & materials about getting proper IV dressings in your area.

[Squeeta2]

My co-workers tell me that even if I didn't initial my IV dsgs they would know I was the one who started the IV...

I still do old school chevron..loop..straight tape and then I cover with an opsite.

It drives me crazy to see an IV site with massive amounts of tape to hold them down...peeling up anyway...and be unable to properly assess the site underneath. For example..if a site is gauzed down or has a white cloth tape down if the nurse who started it didn't note what gauge she started with & now I hafta run blood if I can't dress it down without losing the site I may hafta restick for no reason, not to mention the valuable time I lose if it IS the wrong gauge & I spend 10 mins trying to peel down layer on layer of tape...I coulda had another one in and the fluids infusing!

OK..OK...LOL...I geuss it's a personal peeve!

[nurse_robin]

Did you say you were in L&D? Is it possible that they are not that stringent with IV drsgs b/c they are dc'd so quickly? I've never worked this unit so I don't really know.

[carcha]

mtnmom, we have made for iv dressings here, sterile, consisting of 2 steristrips and a tagaderm that fits around the base of the cannula. we have them in both adult and paed size. their great.

[Nitengale326]

I work post surgical and our policy is cover with tegaderm. HOWEVER, we are forever getting patients up from OR or ER that have a 1/2 pound of tape and no tegaderm. The surgeons will rant and fuss if they see an IV on the floor with just tape but are blind to it in the OR. Our Clin Spec states our policy book is based on Nursing Standards. You might want to investigate that route and present that to the powers that be to get the policy changed. Remind them too that Tegaderm is a billable good where as tape is not.... Can you say KACHING??? (LOL) :rotfl:

[veegeern, BSN, RN]

This is an old thread that I found while doing a search for IV site dressings. Our protocol is to use the occlusive dsg, however we have a couple of MD's on our unit that go through the roof if they find one on their patient. (My understanding is that they were seeing damage to patients' skin when the dsg was removed. I work on an internal medicine unit. Our patients have chronic illnesses, most are elderly, and most have thin/compromised skin.) The result is that our clinical coordinator uses a combination of cottonball with bandaid and or papertape to dress the IV site. The other nurses on the unit either put occlusive dsgs on everyone and to **** with the MD...or they use cottonball/tape/bandaid on everyone. The administration appears to ignore our unit when it comes enforcing IV dsg protocol. So here are my questions:

1. Legally, won't I be held to what is in writing rather than what is in practice on my unit?

2. Is there a trick for removing the occlusive dsg that is placed on fragile skin so that damage isn't an issue?

[ghostcat]

I work post surgical and our policy is cover with tegaderm. HOWEVER, we are forever getting patients up from OR or ER that have a 1/2 pound of tape and no tegaderm. The surgeons will rant and fuss if they see an IV on the floor with just tape but are blind to it in the OR. Our Clin Spec states our policy book is based on Nursing Standards. You might want to investigate that route and present that to the powers that be to get the policy changed. Remind them too that Tegaderm is a billable good where as tape is not.... Can you say KACHING??? (LOL) :rotfl:

You can also remind them that the cost of tegaderm is MUCh less than the cost of a lawsuit for pericarditis from an infected IV.