I have a question about PICC/CVC dressing changes and the removal of the securement device. First here is our senario....We use the StatLock device and have for many years. As a pediatric team we have always utilized a 2+ person dressing change technique. Essentially the 2 RN's will either be the "dirty" or the "sterile" person. One of us has always taken down the entire old dressing (including the StatLock) while stabilizing the line. The other "sterile" RN can immediately finish the procedure. We had always done it this way.
I left for about 3 years to work as a Clinical Specialist in medical device, and came back fulltime in Jan.
I started to notice that a few new nurses had changed the procedure. Basically, they are now donning sterile gloves to remove the old statlock but then NOT changing gloves to finish the procedure. This is my mind didn't make sense. Chlorhexidine only provides the log kill of skin flora for 72 hours right? So then the skin cells and other potentially harbored bacteria are then housed in/on the old StatLock device. Touching and removing the old device, and then placing your hands into the CVC STERILE dressing tray then contaminates everything in there. I started looking around for evidence.
The INS policy and procedure book clearly lines the steps out as I assumed it should be done, but otherwise I couldn't find anything. The INS standards doesn't address nor does the best practice book. I also went to the manufacturer IFU and spoke with an expert from the Bard Medical/Bard Access team that also did not have any solid answers for me. I was told that he had seen it done using both techniques.
So, here is the question.... & I apologize for my winded explanation. What do you you do in your facility?
I am working to change our dressing change policy back and have provided the them the reference as the INS P&P book but would really appreciate your expert opinions and feedback. Maybe I am missing something here.
Thanks in Advance!
~julie
Jules...
OK, so to answer your questions. EVERYTHING under a sterile dressing is considered sterile. That means the statlock is sterile and thus should be removed by a person wearing sterile gloves. The dressing is removed by the person wearing clean gloves. As soon as the dressing is lifted up enough, the sterile person puts their finger on the line without contaminating themselves. The entire procedure is then completed by the sterile person. The risk of introducing bacteria into your site is enormous if you are having the same person remove the existing dressing and also the Statlock that resides under the sterile dressing. It goes back to sterile to sterile is sterile. Everything under your dressing is intended to be sterile and the outside of the dressing is dirty.
As to CHG, the coverage depends on the strength. CHG effects last approximately 24 to 48 hours. ChloraPrep states 48 hours for their 2%. Here is a reference for the 24 hour claim.
The skin can never be completely sterilized. At least 80% of resident and transient skin flora is found in the first 5 epidermal layers of the skin. About 20% of skin flora remains on the skin, even after antisepsis, and bacterial re-growth begins immediately (back to the original level by 24 hours).(http://www.medscape.com/viewarticle/726075)
If using a CHG dressing, the effects of constant contact last about 7 days.
Cynthia Easterling, RN VA-BC
Vascular Access Coordinator
Driscoll Children's Hospital