Sterile Field Question

[walt7878]

Hello,

I observed the circulating nurse pouring Lidocaine onto the sterile field. The circulating nurse opens the med with a pair of scissors, pops the

top and pours into the basin.

From what I understand, they should be using a sterile spike for this procedure, as what the circ nurse is doing is not proper aseptic

technique.

I was reading about using a sterile spike to pour, but nobody seems to

be able to point me to the proper product.

Does anyone know exactly what spike to use and where to get them?

What procedure do you recommend?

Thanks

[RN1989]

Nope, no sterile spike where I worked. Our pourables had caps that came off without doing what I think you are describing with the scissors. Things like lido for injections we would hold the vial upside down so that the scrub could withdraw the fluid using needle and syringe. Takes some practice if you have shakey hands.

[paacollins]

I've never heard of a sterile spike. I've assisted with epidural steroid injections, heart catheterizations, etc during clinicals and preceptorship and the lidocaine packs were always part of the particular kit that we used for a specific procedure. They always had perforated tops that we simply tore off. I've never had to open anything for a sterile procedure with scissors but I would think that by using a pair of scissors that aren't sterile, you would render the pack of lidocaine unsterile.

[nightmare, RN]

Don't these packs have sterile scissors in them?

[paacollins]

Things like lido for injections we would hold the vial upside down so that the scrub could withdraw the fluid using needle and syringe. Takes some practice if you have shakey hands.

When I was doing my preceptorship, we had epi steroid injections first thing in the AM (6 or 6:30). I have fibro and I'm very stiff in the mornings, plus my hands are shakey sometimes. I would be holding the lidocaine vial upside down for the anesthesiologist to withdraw from and I'd have to support one had with the other because of the shakiness. He used to tease me that I drank too much coffee.

[Itshamrtym]

Hi:

We do use the spikes that you are refering @ my hospital. But, I will add that marcaine comes with a metal peel off top that most of the time it breaks and you are stuck... The only way to open it is with scissors or a similar object. We have even been given bottle openers for this purpose from certain drug reps. When I use my non-sterile scissors to open these bottles, they don't touch the rim of the bottle. I will have to say that we are supposed to use the spikes for the lidocaine, but I am so used to using my scissors for the marcaine, that this is what I use for the lido as well..... The way that the marcaine is designed you can't use the spikes. They are just like a bag-o-jet that is used for baci or hep irrigation, but much smaller... Hope this helps..

[walt7878]

Thanks for the thoughtful answers.

The information I've read from AORN and elsewhere tells us to not directly

pour from a med bottle onto the sterile field.

The outer lip of the bottle is not sterile and therefore, it's not good practice.

A lot of the nurses don't like to hold the bottle for someone else to

withdraw for their own safety.

[butterflies123]

Thanks for the thoughtful answers.

The information I've read from AORN and elsewhere tells us to not directly

pour from a med bottle onto the sterile field.

The outer lip of the bottle is not sterile and therefore, it's not good practice.

A lot of the nurses don't like to hold the bottle for someone else to

withdraw for their own safety.

I have another question about sterile technique. If your room is "open" that is the packs, instruments, sutures etc for the case are open and you find out your case will not be 'happening' for another 2 1/2 hours due to a delay, should you cover the sterile field? If so, how and how do you remove the cover?

[Itshamrtym]

I would say that this is too long to remain open for a case. If possible use it for another similar case, or break it all down and throw out...

[buck70]

I agree with Itshamrtym. If you can use some or most of the set-up for another case, that is okay. I know sometimes this isn't possible. 21/2 hours is too long to try to monitor a field. It is not recommended to cover a sterile field. The risk of contaminating it, that way, is higher than just leaving it alone. A sterile field becomes more and more contaminated (by the environment) the longer it is open. If you are doing a procedure, you can't help it; however, you can prevent, or slow, "time related" contamination by using the sterile field/set-up as soon after opening as you can. It is interfering with continuity of care to use an "aged set-up" on one patient, and a "fresh set-up" on another. Simply put: "use it, or lose it!" :wink2:

[buck70]

By the way, shodobe, if you are out there. We know you would use it, and say "F" it..........................Ha Ha. All in good fun.