Mistake-broke sterility

[newbie3]

I am in my last semester of school and I have clinicals in ICU. Well my preceptor had me change the inner cannula on a trache. The patient had the trache for years (metal type) and they changed it to a plastic one a few days before. I was wearing clean gloves and was told not to touch the part that goes in. Well even though I knew not to touch it I somehow managed to while trying to insert it. I didnt even realize I did it until I put it in and thought about it. My preceptor never said a thing, but I feel like a complete idiot. My preceptor is really cool but I was hoping for a recommendation from him and I feel like I blew it. Any advice or words or wisdom would be appreciated.

[seconddegreebsn]

Here's the thing about learning: you're going to make mistakes. Even as a new nurse, you will make mistakes. What separates the good nurses from the bad ones is those who 1) are able to recognize that they did something wrong, 2) take the appropriate steps to remedy the situation, and 3) LEARN from it. This is not something big enough to beat yourself up over. If your preceptor didn't say anything, there's a chance they didn't catch it either, so just take this and learn from it and know that you'll do better next time.

[Katie71275]

Absolutely agree with the above poster. You recognized your mistake, and next time will think about it and not do it again. No one is perfect, we all make mistakes. I, as a new nurse, make mistakes all the time. Seek advice from your more exp nurses and preceptors and make sure you don't repeat the same mistake twice(but if you do..again it's more than likely ok-just learn from it!)

I'd be pretty surprised if your preceptor hasn't had something like that happen to him at one point.

[SopranoKris, MSN, RN, NP]

We just did our skill check off for trach care. Our instructor told us to hold the cannula so the part you're holding is away to the right (if you're right handed). That way, when you insert, you can get better leverage to push it in without being tempted to touch the cannula with your fingers as you're pushing it in. (You're kind of pushing it towards you). It's hard to describe without showing you in person. Hope this makes sense!

Don't beat yourself up! The good thing is YOU realized what you did. I bet you'll never forget it now :)

[BostonFNP, APRN]

We all have made mistakes. And will continue to make mistakes. We do out best to limit them but they happen.

"I thought I made a mistake once but I was mistaken."

[nurseprnRN, BSN, RN]

Trach tubes are not sterile. Clean technique is perfectly OK for a chronic trach. This is likely why your preceptor didn't mention it.

[Rose_Queen, BSN, MSN, RN]

Heck, trach insertions done in the OR are only sterile until the ET tube is removed and the trach cannula pushed in. Then anesthesia passes the airway circuit (completely non-sterile) into the surgical field for the surgeon connect to the trach. At that point, sterility is out the window. Generally, at this point the only thing left to do is secure the trach and place dressings. Think about the respiratory system- it isn't considered a sterile environment.

This is the wound classification we use at my facility, and it shows you that while the surgical instruments are set up sterilely, they may not stay that way because of the surgical site:

[h=2]Surgical Wound Classification[/h][TABLE=width: 100%]

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[TH=align: center]

Class I/Clean:

[/TH]

[TD]An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tract is not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria.[/TD]

[/TR]

[TR]

[TH=align: center]

Class II/Clean-Contaminated:

[/TH]

[TD]An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, lady parts, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.[/TD]

[/TR]

[TR]

[TH=align: center]

Class III/Contaminated:

[/TH]

[TD]Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered are included in this category.[/TD]

[/TR]

[TR]

[TH=align: center]

Class IV/Dirty-Infected

[/TH]

[TD]Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated

viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.[/TD]

[/TR]

[/TABLE]