Hello
I am curious to know what the standard procedure is for other organizations for removing the STATLOCK during a CVAD dressing change. Our current policy is to remove the dressing with clean gloves (including the SL) and then apply sterile gloves, clean and reapply SL and tegaderm. I was taught that anything under the tegaderm should be considered sterile and therefore was taught to remove the tegaderm and apply sterile gloves prior to removing the STATLOCK that is under the tegaderm.
It does make sense to me that you would remove the old SL with clean gloves rather than your sterile ones but I would like to know what the common practice is. This step is not clarified in my INS textbook or CDC guidelines or any other respources that I have looked through
Thanks in advance for your feedback.
Tammy
That is the way I teach a sterile dressing change as well. Remove everything and then DON sterile gloves; perform a sterile cleansing of the skin; and then the new catheter securement device is placed after the area is dry followed by a TSM.
I agree - take everything off with clean gloves, change to sterile for skin antisepsis and applicaiton of new disc and stabilizaiton device. Skin can never be made sterile, so once these devices are removed from their package and placed on the skin, they are no longer sterile. 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
the problem with the technique below is.......if you remove the outer dressing with clean gloves, then continue with your clean gloves and remove the statlock you are touching the wings of the PICC line with non sterile gloves. We have to unlock the statlock and then literally lift up the wings/anchors on the picc to hold up and remove it from the statlock. So now.... you put on your sterile gloves and go right back to hold the picc line anchors to lift it up to properly clean , and or reposition and you have promptly contaminated your gloves.
We treat everything under the dressing as sterile ,which includes the statlock device and the anchors of the picc line. Remove the dressing with clean gloves, apply sterile gloves, place small drape under site, remove statlock, that sometimes requires alcohol swab, we use the sterile one in the kit. Then using chg swab cleanse the insertion site and surrounding skin and only controlling and manipulating the picc lien by holding onto the wings/anchors. After chg dries, then apply sterile skit prep, statlock , biopatch and sterile tegaderm dressing.
Gina Ward R.N., VA-BC
I use the sterile gauze from the kit to pick up the PICC to clean under so my sterile glove does not get contaminated. Does that make sense?
Valorie Dunn,BSN, RN, CRNI, PLNC
We may be splitting hairs here. Nothing under any dressing is sterile. Skin can never be made sterile. Organisms that reside deep in the layers of skin are constantly coming to the surface. Applying antiseptic agents to the skin surface is only reaching what is on the surface and not these organisms deep in the layers. So that is probably the reason that the CDC guidelines state either clean or sterile gloves. What I am more concerned about is where those gloves are taken from. Boxes of exam gloves have been shown to have a contamination rate as high as 80%! 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
Yes, all the more reason to wear sterile gloves for the entire process once the outer dressing has been removed , which includes removing the statlock and picc line wing manipulation.
I realize the skin is not sterile , but......at least if we are utilizing sterile gloves we are not adding to...the possible contamination.
Gina Ward R.N., VA-BC