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mmcerle1
StatLock removal; sterile gloves to remove or non-sterile

Question for the group:

When performing a Central Line Dressing change and the StatLock is under the TSM dressing, do you remove the StatLock with your non-sterile gloves or do you remove with sterile gloves?

I have always removed with sterile gloves. I am being challenged by some excellant RNs, that the StatLock is not sterile and should be removed with non-sterile gloves, then apply sterile gloves and proceed with the chloraprep.

My concern is the non-sterile gloves have touched the dirtiest part, the old dressing, and would contaminate the suture wing with more than just resident flora from the skin.

If the site was grosly contaminated with stool/urine, would use two Chlorapreps (or betadine in the old days) i.e. fem lines, but would change the sterile gloves after the first chloraprep, then reprep.

Please any feedback?

mary ann ferrannini
We remove with non-sterile

We remove with non-sterile gloves..then of course clean the entire area,including th skin that was undert the stat loc with CHG and all sterile products. Just an aside you may also want to consider using some sterile saline to clean the skin..let that dry..then use the CHG..let that dry,of course.

DSB
Tape can be your best friend

Put a piece of tape just outside the dressing area but as close as possible. It's the first thing I did before starting the dressing change. It will help tremendously in keeping the catheter in place while you do the dressing change. Remove it when you complete the dressing change. I have shown this to many nurses and they all agree it is crucial to not accidently pulling out the PICC line any and helps keep it in place while cleaning. If you're not doing this alredy, you will be amazed as to how much this helps.

Clean gloves to remove but always maintain aseptic technique where it counts. Never touch the insertion site, it's not necessary. Sterile field and sterile gloves once the old dressing (including Stat Lock and Biopatch) has been removed). Don't forget about the ports. Lots of nurses change the dressing but neglct the ports. Of course the ports can be changed with clean gloves using aseptic technique.

Dale

mmcerle1
Maryann: I appreciate your

Maryann: I appreciate your response.

I have to say that I am dumbstruck that after removing the dirtiest part (external dressing) then reaching under and removing the STATLOCK with these same gloves wouldn't increase the bacterial load on the suture wing. I understand there is resident flora under the dressing, on the STATLOCK and underneath, but to then further contaminate with what is on the dressing? I work in peds and who knows what the kids have wiped on their dressing, let alone the femoral catheters or subcalvian/Jugular cathteters with the oral pharangeal secretions.

I also teach to wash off any obvious contaminate or blood with sterile gauze saturated with sterile water or sterile NS prior to the Chloaprep.

Moira McErlean

pallik
Statlocks are pretty close to

Statlocks are pretty close to the insertion site.  I use only sterile gloves to remove the statlock.  Because the dressing will sometimes adhere to the statlock, I will don 1 sterile glove under the dressing to hold the statlock down while completely removing the transparent dressing.  With sterile gloves I remove the statlock.  Anything non-sterile under the dressing would potentially compromise the site.  Why would we use sterile gloves with the chloraprep when cleansing the area under the dressing (when we are not actually touching it)but not use them when we are fidgeting to remove the statlock.  The statlock was sterile straight out of the package when we placed it.  I would think in the best interest of the patient, to prevent potentially compromising the site to wear sterile gloves. I agree with you. Does the packaging say the statlock is not sterile?

Robbin George
Here is how I do a sterile

Here is how I do a sterile CVC dressing change

Position patient

Open sterile dressing kit--Mask is on the top

Don mask

Drop Biopatch and Statlock onto the sterile field

Hand hygiene and don CLEAN gloves--You change endcaps at this point or wait until after the dressing change

Remove all old dressing materials EXCEPT statlock

Repeat hand hygiene and don STERILE gloves

Place sterile drape from kit below catheter [Under the arm for a PICC/On the chest for SC or Jugular]

Take 2 sterile 4X4s from the kit and use them to open the Statlock/Lift the catherter out of the device/And remove the old Statlock

Wrap another sterile 4X4 around the hub end to facilitate lifting the catheter up to clean the skin under the flang

Use sterile alcohol swabs from the kit to remove old adhesive and dead skin cells/Allow to dry

Activate Chloraprep and starting at the insertion site vigorously scrub the entire skin surface that will be under new dressing/Allow to dry

Apply skin prep/Allow to dry

Secure new Statlock and Biopatch with Transparent dressing/Apply additional skin prep to top edges of Transparent dressing

You can change endcaps now if you did not do it before starting the dressing change process

"Autograph" dressing with date and initials

 

 

 

Robbin George RN VA-BC

bcupach
PICC drsg

I have a question that our facility is having some issues with, How do you prevent the PICC from dislodging or becoming contaminated when you leave the patient to wash hands before donning sterile gloves? I am finding mixed literature out there and cannot find a concise answer for best practitce. On CDC website, the procedure they link to does not have you wash hands, and TJC is stating that dislodgement and contamination are more important, so i am very confused and we need to find the answer. Thanks.

lynncrni
CDC guidelines from 2002

CDC guidelines from 2002 stated that clean or sterile gloves may be used for CVC dressing change. There is actually nothing sterile under a dressing as skin can never be made sterile. I have always removed the old dressing, stabilization device, etc with clean gloves, then changed to sterile gloves to apply the new. But it is possible to use clean gloves to also clean the site and apply a dressing. The TSM dressings usually allow for application without touching the sterile adherent part. So it is posslble to use clean gloves for the entire procedure. Is it the best practice? Don't know because there are no studies that have answered this question yet. Lynn

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

daylily
I perform the exact procedure

I perform the exact procedure as described by Robbin George except in our kit are (2) 2x2s.  I unfold them and use one to stabile catheter, remove biopatch, and unlock statlock while the other hand is peeling dressing off.  The other unfolded 2x2 is placed over the catheter extensions to life catheter out of statlock.  My thoughts are the sterile 2x2 creates a between what was so called sterile under the dressing and my clean gloves.  Once everything has been removed I don my sterile gloves.

Mats Stromberg
2 pairs of gloves.

We will use clean gloves, one pair to remove the old and one to apply the new. Hands that take out and don the clean gloves are always clean and desinfected. We do not see many infections.

Mats

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