Picc line dressing change broke sterile field

[Goofaroo]

I did a picc dressing change and after I removed the old dressing I couldn't get the blue bio patch off the patient it was sticking to their skin so I used my hand to grab it off. I then put on the sterile gloves and cleaned the area. As I was using the tweezers to put on the new bio patch it slipped out and landed on the patients gown I quickly picked it up. I feel like I should have got a new one but I didn't and now I feel guilty! I'm worried the patient will get an infection and it will come back to me. I'm new an still in training but my preceptor let me do the dressing alone. Any suggestions ? I'm worried.

[JadedCPN, BSN, RN]

That absolutely was a breach of sterile field and you should have either called to have someone bring you a new biopatch so you could remain sterile, or (depending on your facility's protocols) placed a temporary occlusive sterile dressing over the PICC, obtained an entire new sterile dressing kit with new biopatch, and started from step 1 again.

And yes, it is an infection risk. At least in pediatric world, patient gowns (besides obviously not being sterile in the first place) are usually disgusting and spiked with crumbs, fluid stains, and who knows what else.

Is the sterile dressing change something you felt comfortable with? I am assuming it if you didn't understand the basics of sterile field and why you shouldn't have placed that biopatch on. If not, you shouldn't have done it without your preceptor even if she was okay with you doing it on your own. Next time just tell her you would like her to be there to observe and assist if needed since you are newer to it.

Lastly, your concern shouldn't be about whether this will "come back" to you but your primary concern should really be about your patient's risk for infection. You had several opportunities during and after the dressing change to speak up and ask if you should have got a new one because you weren't sure, but you didn't. Take it as a learning lesson for future dressing changes.

[JKL33]

When I am precepting I suggest the nurse have a 2nd kit in the room/anteroom - - it makes it very easy to "do the right thing." This is very useful especially when performing something like urinary catheterization of any kind, since people tend to poke around in the wrong...place...and then think they can still use that catheter.

You'll get the hang of things, but you have to be willing to do what you know is right...otherwise there's not really a lot to work with.

[iluvivt, BSN, RN]

Was this a pediatric patient because you can toss a biopatch onto your sterile dressing kit area and pick it up with sterile gloves. You can squirt some sterile saline on a stuck biopatch and it will puff up and make it easier to take off.... Just warn the patient so they do not jump. Yes... you should have used a new and sterile biopatch. I always have separate extra ones with me in case and then I do not have to waste another CVAD dsg kit. You broke sterile technique and should have made sure PICC was secure.. take off sterile gloves... get a new biopatch... toss it onto sterile area.. reapply sterile gloves... proceed with dressing. Hopefully the CHG will kill any bacteria it may have come in contact with...but you know now.. Not to do it ever again