Our hospital has begun inservicing for a new dressing kit that includes a clear dressing that would secure the hub of the central line under it. This is a variation from our current practice of having the hub exposed through a slit in our current product. Thoughts on having the non-sterile hub under the dressing? The reps advocate cleaning the entire exposed line and hub with CHG, as well as the skin-catheter junction.
Thanks,
Kristi
I am confused about exactly what you are calling "the hub". Most of the PICC lines I see have been inserted leaving at most a 1 cm external catheter so if you are meaning the "wings" that the statlock secures, it is always under the sterile dressing. If you could clarify we might be able to assist you better. Sorry. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
I'm talking about a non-tunneled, temporary CVAD that is not a PICC line.
Kristi
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
Valorie, I had to go to the Bard website to verify "the hub" as well. Bard does refer to "reverse taper hub" on the bottom of this page: powerpicc.com/cat-features.php
Kristine, what I have seen pretty much across the board is the hub attached to a stat lock or the new orange doodad or sutured and under the sterile dressing with the infusion extensions exiting the slit in the dressing. The exception is when the line is long with more than a couple centimeters external, and the hub with whatever anchoring device is outside the sterile dressing.
I missed the "not a picc line" part. I should have read more thoroughly before responding.
Sorry to not be clear. On our temporary CVADs, not PICC lines, some of our units are questioning placing the external components up to the bifurcation of the lumens under the sterile dressing. Is is standard practice to clean the entire line itself with CHG, in addition to cleaning the skin? Does anyone have a really good reference for this practice? The INS standards are fairly vague. Thanks.
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
For all CVADs, the female luer locking hub must be outside of the dressing so it can be easily reached for changing IV set, injecting meds, etc. The area of the external catheter placed under the dressing should include a sufficient length to adequately secure it with a stabilization device. That is different lengths depending upon catheter design, insertion site, what is comfortable for the patient, etc. When using CHG with alcohol (the only available solutions in the USA), you have to know what catheter material is used to construct your brand of catheters. Polyurethane catheters do not tolerate alcohol. Read the instructions for use for the specific brands of CVADs in your facility, especially the warnings and precautions section. Also, the INS Standards are not written to be a step-by-step procedure. They provide information about what is necessary to meet the minimum level or standard, but there could be several acceptable procedures to meet that standard. 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