Hello all, long time reader, first time poster :)
In order to reduce our CLABSI rate hopefully to zero, my hospital is in the process of creating a central line team, so to speak, that will be doing most of the picc line and central line dressing changes. In a recent meeting we were discussing our picc drg change procedure to see if it needed any updates and to ensure consistency in our group's practice.
We have central line drg change kits at our facility that have 2 pairs of sterile gloves in them, and our current procedure is to put on the first pair of sterile gloves and remove the old tegaderm, statlock, and biopatch and then to put on the 2nd pair of sterile gloves and clean with CHG swab, apply skin prep, place new statlock, place biopatch at site, and apply tegaderm.
Personally, I have never liked this way of doing the drg change as I feel that placing the biopatch at the site after picking up the picc hub to place it in the statlock is a possible source of contamination. Even if the picc hub has been cleaned front and back with CHG, it isn't sterile. And in order to properly place the biopatch, it's almost impossible not to touch the picc line right next to the entry point into the skin. So my routine has been to use clean gloves to remove the old drg/biopatch/statlock, then put on sterile gloves to clean the site and hub and apply skin prep and place hub in new statlock, and then to change into the 2nd pair of sterile gloves to put the biopatch on at the site and then of course the tegaderm. In my opinion, placing the biopatch is the point of the procedure when I have the closest contact of my hands with the insertion site, and thus I should be as sterile as possible at that moment. If I've touched the picc hub prior to that, I feel there will potentially be organisms on my gloved hands.
I brought up my concerns etc. and since have been asked to find evidence in the literature of the need to change gloves prior to putting on the biopatch. I can't find any and frankly don't think there is any. Which is why I am posting here on the forum to get the opinions of the many experienced experts that visit here. So, my question is this: does it make sense to change gloves in the manner I described for the reason I listed, or am I just being a nervous Nelly? Is the status quo way of just using one pair of sterile gloves (to clean the site, apply skin prep, put the picc in the statlock, and then place the biopatch at the site) really the best way to do it? Wouldn't it be just a little bit safer to don another pair of sterile gloves prior to biopatch placement or is that just an unnecessary step?
I look forward to hearing your opinions,
Sam
-btw, I'd just like to state that although this is my first post, I've been following this forum for years and refer to it all the time, and all the great information I get out of this forum is much, much appreciated!
Sam. I like to err on the side of caution myself. I have in the past used the 4X4 sterile gauze in the dressing change kit, place in my nondominant hand to pick up the PICC line so I do not contaminate that glove. Mybe I am misunderstanding the correct placement of the biopatch, but I was under the impression that the slit is to be placed down toward the wings on the PICC covering the insertion site (that is how our hospital IC nurse has instructed any way) so raising the PICC to place it would not be necessary. In home care we have had multple issues when the slit is place the other direction and the tegadrem is stuck to the biopatch. It has taken several minutes longer to get the tegaderm off of the biopatch and not pull the line out some. Some input please from others about proper placement of the biopatch concerning the direction of the slit if there is a proper technique for that. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
valorie,
per the biopatch directions, the edges of the slit should go under the picc line and touch together under it if at all possible with the slit located at 5 or 7 o clock (the picc itself being at the 6 oclock position). The directions state that in order for it to work to it's maximum effectiveness the biopatch must touch the skin all the way around the insertion site and that the edges should meet up under the picc. Simply laying the biopatch over the picc at the site isn't recommended. The only way to do this is to lift up the picc a little or use your fingers/thumbs to push the biopatch edges under the picc.
sam
I have always removed the old dressing with a clean pair of gloves, used 1 pair of sterile gloves to prep the area, then a second pair of sterile gloves to apply the new dressing. You are correct about there being no research on this. I do think your procedure and rationale are on target. 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
I do many joint visits and competency check with infusion nurses in the home. I have always taught as you have stated that the insertion site should never be touched by clean gloves or contaminated sterile gloves. I helped design our central line dressing kits and we have 2 pairs of sterile gloves in our kits. I teach clean gloves to remove old dressing and statlock. If the biopatch can not be removed easily when the tegaderm is removed then the nurse must remove her/his clean gloves, use hand sanitizer and put on sterile gloves to remove the old biopatch. Then the nurse must remove the contaminated sterile gloves, use hand sanitizer and don the second part of sterile gloves to cleanse the area and apply biopatch and then statlock.
Carole Rumsey, RN, CRNI
Home Infusion Program Manager
Sutter Infusion and Pharmacy Services
Sutter Care at Home
Northern CA
[email protected]