Should we stay sterile or not?

ShariDCST · Mar 8, 2008

hey,
my scrub tech asked me question the other day which i didn't have an answer for...so we did a tracheostomy on this extremely sick guy. he was superhigh risk - 500 pounds plus, vented..and all that jazz. so finally we were done with surgery...surgeon left, resident left...anesthesia is all nervous cause they decided to put central line and cardiovert him postoperatively. i was cool with that but then tech asked me if she should stay sterile for central line and cardioversion...i was like...just keep the back table sterile in case...tech said that some nurse like scrub to stay sterile and others don't care.
luckily for the patient anesthesia fixed him allright, hr :heartbeat became normal and central line was put like in the books.

in a case like that, it's always been my personal practice to stay sterile until the patient is either declared stable, or has left the room, or both. it depends on the specific situation - but for something like what you've described, i'd stay sterile until the patient left the room. once you drop out and break scrub, precious time can be lost rescrubbing, gowning and gloving if something goes wrong before then.

if your department doesn't have a policy for something like that to guide you, it might be a good idea to consult whoever is in charge of clinical education for the unit. that person should have some guideline, or help get one established. :specs:

mcmike55 · Mar 15, 2008

Staying sterile or not at the end of a case comes up at our hosptial every once in a while. Our biggest concern is on major vascular cases, where things can happen fast, and, if contaminated, we don't have a back up set of instruments immediately available. Add to that, the time (which we wouldn't have) of setting up again.

What we do is the back tables remain "up" until we are out the door heading to the PACU, and all is well.

The tech dropping out or not, really depends on the situation. If we are after hours and alone, I need the tech to help move the pt. Then, they'll stay gowned, but contaminated. If they need to get sterile again, it's not such a long time, and there likely will be a little time, prep and all before they're "on" again.

In your situation, I can see your point. I thought it was a good move on the tech's part to ask first. Some of what you did after the trach, did you really even need the tech to stay scrubbed? Just asking.

Mike

jdg0719 · Sep 3, 2010

When in doubt, in cases like this, best thing to do is check with anesthesia before you break down

Mr. & Mrs. RN · Sep 3, 2010

Yes, I would go with the anesthesia preference.

canesdukegirl, BSN, RN · Sep 6, 2010

I personally would stay sterile. Especially in the scenario you just described. If we were on PACU hold or something, then I would let the tech go. In my hospital, the policy is that the tech does not have to stay sterile, but I disagree with this policy for exactly the kinds of patients you described. It is just good nursing practice in my eyes to stay sterile so that no time is wasted. You just never know. This pt obviously has comorbidities.

Another question I ask myself when faced with a "grey zone" dilemma is this: if the patient HAD gone south, what would I feel? Would I know that I had done my best and made the right decisions? Better to be safe, and be patient.

Argo · Sep 6, 2010

Here is a good thought process to follow...

1) HAs the patient left the room? if not-no, if so then..... next

2) Do you have another set up immediately available if you break down? if not - no.... if so then next....

3) ask the anesthesia provider and the RN in the room if it is ok to break it down. Usually for hearts my techs wait until I call them from the ICU to make sure there is not excessive drainage on the pleuravacs when we hook it up to suction in the unit and the patient is stable.....

If the patient has left the room and we have another set up immediately available then break the room down....