Standard 49 III (PICC) IV (Nontunneled CC) Practice Criteria Item G does not designate removal of these CVCs as a sterile procedure but a colleague who is preparing for the CRNI exam is confused as to the language that states "Digital pressure should be appled until hemostasis is achieved, then antiseptic ointment and a sterile occlusive dressing should be applied to the access site"--Could someone please qualify the terms STERILE and OCCLUSIVE as used in these statements--We have been using vaselline gauze covered with a 2X2 (some pt are allergic to antiseptic ointments) and tape--Thank you in advance of your responses
This means that the dressing left remaining on the insertion site of any removed CVC should be one that adequately seals off the skin-to-vein tract. This is accomplished with a petroleum-based ointment and a dressing. Neither a TSM nor gauze and tape would prevent air from being pulled into this tract. The ointment seals off this tract while it epithelizes. This prevents dangerous air emboli!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Robbin George RN VA-BC
I have never used a sterile procedure to remove a CVC even when I was taking a culture of the tip. The external catheter that you are touching was only sterile when it was removed from the package. When removed the sterility of the external part is long gone. You can remove this with clean gloves and still use sterile scissors to amputate the tip into a sterile cup with a no-touch technique.
For the dressing on removal, this is the same as any dressing. CDC guidelines state you can use clean or sterile gloves to change the dressing. It would require use of a no-touch method of squeezing the ointment from a foil package directly to the site and them application of a dressing that has paper tabs for holding and not- touching the adhesive part. It is often easier to use sterile gloves when the available supplies do not allow for this no touch technique.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861