I need information on the best practice for opening and setting up sterile field before PICC insertion.
We are modifying our practice at the facility I work in and several co-workers have come up with possible issues.
Is it indeed true that 2 RNs MUST be present when opening up sterile packages as the PICC sterile field table is set up? I am being told that 2 RNs have to be in attendance, and that one of them is to make sure the one that is setting things up does not break sterility. I am a bit skeptical of this, since I have asked staff in the OR and IR if they indeed follow such policy. I have been told it is preferrable to have 2, but not necessary, provided one know how to use and, indeed, uses aseptic techinique. They also do not always use RN, but OR techs. We have worked as a team for years, and have worked solo during the week-ends, setting ourselves up. Now the facility is asking us to work alone at all times, using a floor RN in the room with us from the time we do a TIME OUT to the end of the procedure. The majority of our team wants a RN to be in the room when we open our supplies, so that is what is being done. Of course, the RNs in the units are not pleased, since having to come into the room with us takes them away from their patients for a longer time. Some of the issues brought to light are CDC guidelines and best practice. We just want to make sure we are doing things correctly, and we do not open ourselves up for eventual problems.
If I could get some guidance as to where I could find literature that clarify this issue, I would be certainly very grateful.
Maria
There are no standards or guidelines about how many RNs or other clinicians are needed when opening up or using sterile technique for insertions. Look to what your hospital does for other catheter insertion procedures--if an MD or othe clinician inserts a central line, do the do it alone? Who else uses the central line checklist in your hospital? In those cases, and departments, are the procedures done solo? Take this information to your infecton control and risk managemnt departments. PICCs should be treated the same way as any central line insertion procedure.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Thank you Chris. Maria
I agree you do need to check with what your hospital has as a policy. I do not use two nurses to verify sterile setup of the tray. However, my nurses do have to mark they did not break sterile technique, a second nurse is brought in for the purpose of the time out, my nurses are required to tie the back of their gown when inserting os that takes a person to tie it which can be done soon after the timeout. Also take a look at your central line bundle..there is generally a checklist required as part of it that is filled out..that checklist has on there what was doen during the procedure. More importantly, we follow our infection control 48 hours post insertion which show a zero percent infection rate..maybe infection control can work with you in trackign this process. There is so much more to maintaining sterility with a PICC insertion then just the tray.
Jamie L Hamm RN, BSN, VA-BC
CEO
Vascular Access Plus
Only 48 hours of follow up? The risk of infection associated with the insertion can last longer than 2 days. It is more like 7-10 days. After that the risk of infection shifts to the hub and intraluminal causes. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861