More sterile questions!

[garciadiego]

When changing PICC line dressing and you have removed almost the entire dressing except that last part that is covering the site, don't you have to stabilize the line with your finger so it won't get pulled out? But then the line or the site/area wont to sterile any more.How do you get that last part off?

[chare]

You can use the tip of a sterile cotton swab to stabilize the line at the insertion site when removing the dressing.

[garciadiego]

Thank you chare. That is a brilliantly simple solution and I'm embarrassed I did not think of it. Peace be with you.

[IVRUS, BSN, RN]

With a PICC dressing change,

First.. Follow your agencies policy. And, If there isn't said policy, develop it! But, Here's how I do it:

First, after I remove the TSM and any anchoring steristrips or catheter securement device, then I take a piece of tape and secure the catheter's lumens to the forearm. Then, rewash hands, drop any other supplies such as another statlock of winggaurd securement device and the new injection cap into my sterile field. Then DON sterile gloves, cleanse site, allow to dry, then put another catheter securement device on its wings and secure to skin, follow this then with a Transparent sterile membrane (TSM) from your kit and secure the end where the catheter is coming out of the dressing with another piece of tape and place label and remove the anchoring tape.

[garciadiego]

Thanks, but arent the lumens sterile? Is the tape sterile?

[garciadiego]

Since we are talking in PICC line here, I thought I would put this request on this thread.

There are different ways Youtube videos show the PICC dressing change. I would appreciate it if you all would critique it..... Take opsite off clean gloves, hold line with clean gloves to stablizie and pull opsite off, take stat lock off with same clean gloves, holding line and touching skin to get lock off. Put sterile gloves, clean with cloroprep, lifting line with the sterile gloves to clean the skin under line, the procede with to put statlock and opsite on with the sterile gloves. Thank you

[garciadiego]

I watched on Youtube "I just watched "Bard Medical STATLOCK....", which explains my questions, therefore please disregard my most recent post, thanks.

[CapeCodMermaid, RN]

Homework quesstions

[Bedside_Life RN]

With a PICC dressing change,

First.. Follow your agencies policy. And, If there isn't said policy, develop it! But, Here's how I do it:

First, after I remove the TSM and any anchoring steristrips or catheter securement device, then I take a piece of tape and secure the catheter's lumens to the forearm. Then, rewash hands, drop any other supplies such as another statlock of winggaurd securement device and the new injection cap into my sterile field. Then DON sterile gloves, cleanse site, allow to dry, then put another catheter securement device on its wings and secure to skin, follow this then with a Transparent sterile membrane (TSM) from your kit and secure the end where the catheter is coming out of the dressing with another piece of tape and place label and remove the anchoring tape.

Before removing the "TSM" the patient and the Nurse should don masks. The lumens (or extensions) should be replaced when the caps are changed. The time that you should sterilize these ports should be 15 seconds of frictional rubbing and then allow it to dry.

The new, sterile items should be placed on your sterile field and covered with a sterile towel so that you are not allowing so much exposure time to the insertion site of the PICC. If you have to leave the op-site open to air or turn your back on it to "rewash your hands and drop supplies onto the sterile field then sterility is compromised. Get everything you need that is sterile ready first. Do not ever step away from the sterile field to go wash your hands mid-way through, leaving the site uncovered and exposed. Also, you cannot just cover the site with a TSM alone. You need to have a new biopatch that will replace the older one.

It would also be good practice to document the condition in which you found the dressing and site in regard to being clean,dry, and intact. Also that the PICC lines draw back or at least which one draws back.

The nurse will need to know this.

It is also a good idea to remember which line has been flushed/hep locked by leaving the syringe attache to the extension port until you come to the next one.

[IVRUS, BSN, RN]

Yes, you are correct. I left the "given" step-by-step's out of my directions. But I agree that masks should be put on before the old dressing is removed, and that hands should be cleansed with hand gel so as not to leave your sterile field. Biopatches are great, but not always used and aren't always mandatory, and usually they require an MD's order for its placement, especially for reimbursment purposes.