We are in the process of updating our central catheter removal procedure. Currently, our procedure states to use clean gloves to remove the dressing, then wash hands and change to sterile gloves to remove the catheter and apply the dressing to the insertion site. We are questioning whether sterile gloves are actually necessary to remove a CVC....any comments? My population is all neonatal and pediatric, so to leave the child's arm go once the dressing is off, go and wash your hands, put on sterile gloves and come back to finish the procedure, may not be practical unless an assistant is available to help hold. We do use vaseline gauze or antibiotic ointment on gauze to cover the site, then transparent dressing.Â
Thanks for any input....
Anne Marie
Anne Marie Frey, RN, BSN, CRNI
The Children's Hospital of Philadelphia
This process does not sound very good for any age patient with regard to air emboli unless you do have an assistant to hold the needed pressure. CDC guidelines state that clean or sterile gloves can be used for regular dressing changes. So why make the removal a sterile procedure? I have always used clean technique on adults. At removal, air emboli is the biggest risk not infection. If infection is going to happen it will be caused by the breakage of biofilm as you remove the catheter, not from the open hole when the catheter is gone. But air sure can get in and do lots of damage!
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
HOME CARE CAP CHANGE INTERVAL
Our current in-hospital policy is to change the cap [Alaris Smart Site valve] every 72 hours. Our home care, who does a weekly visit for CVC care [depending on type of therapy], would like to change the cap on a weekly basis to coincide with the weekly visit. Do any of you home care specialists out there have an opinion on this practice? The CDC guidelines say change cap not more frequently than every 72 hours, so both practices fall into acceptable range, but we would prefer not to have two differenct procedures/policies.
Thanks in advance,
Anne Marie
Anne Marie Frey RN, BSN, CRNI
Clinical Nurse Level Four
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]