Forum topic

 I am not aware of any research on this issue, but it makes good sense to me. I have always placed a sterile towel under the arm especially during the skin prep. If your swabsticks touch the bed lines, they are contaminated. The sterile towel prevent this and make keep the linens from getting wet with the prep solution. A manufacturer is going to put items in their kit that customers have told them they need. That does not automatically mean that the item will always be used in the same manner by each person. They are trying to meet the needs of the majority of customers. Lynn

While I'm not a proponent of "because we've always done it that way", I think there are elements of our procedures that don't necessarily need studies to back them up because it makes good sense with the science and principles of asepsis (though studies would be helpful, it would be hard to tease out from other variables what caused an increase in infections, and I doubt anyone would do a study just on the underdrape).

Our PICC assistant preps the underside and top of the arm using at least 2 10.5ml chlorapreps (more if the patient is obese - one 10.5ml prep covers 8x10"). A fresh sterile drape is placed under the arm before the arm is laid down.

Mari Cordes, RN VA-BC
Fletcher Allen Health Care
Burlington, VT

I alway do!  Gives me a barrior between the bed and my field while providing some protection the the bedding related to procedure fluids!

I utilize the drape under the arm and tourniquet, but not in a sterile manner.  What is your input on this?

first; in the Bard kit; the under arm pad and the chloraprep swab sticks are loose and not packaged seperately . you have to open the sterile glove pack to get your tourniquet , and mask too .

I have washed my hands, opened kit and placed package with sterile gown in it on pts lap ( keeping closed)

then..  open glove package put on mask and take out tourniquet, take tourniquet and drape and place under patients arm , sliding tourniquet high up and off of my working fiield , positiioning arm as desired and moving all lines and cords hooked to patients arm out of working area as well, all of this ungloved.  ( i always wear a hair cover)

then wash hands with foam cleanser then take tinted chloraprep swab ( only holding handle) and cleanse all of the upper arm that is exposed , careful not to touch the tourniquet ( since not sterile or the bottom pad) and do the edges of arm that contact the drape then discard, then repeat cleansing with second chloraprep stick  in same manner then allow to dry

while drying , i have cleansed my hands again and then open the insertion kit and drop all items on sterile field then...

back to site and with cleansed hands, not touching any of my prepped arm tie off the tourniquet , then cleanse hands and don gown, gloves and drape patient and begin procedure.    When I apply the drape with adhesive to the insertion site the entire working area is sealed off and none of the tourniquet or under drape are exposed keeping my entire area sterile.

Before they packaged the kits differently, I did apply the under drape and tourniquet with sterile gloves, but they both quicly become unsterile with the multitude of accessories on our patients.

The drape is definitley needed with containing any blood that comes from introducer, but my question is sterile versus non sterile.

Thanks in advance,  Gina Ward R.N.

what is the consensus on sterility of the undearm drape?  see my below note.

thanks,  Gina