We have experienced several instances where a patient requires use of their port a few days post placement. If the patient is going to IR for port placement and will stay an inpatient where the port will be used immediately, IR will leave the needle in place. So there is no problem.
The problem presents when the patient arrives for port use and the steri strips are over the pocket incision line and/or over the port septum.
We have cleaned with chlorhexidine over the steri strips and to the best of our ability allowed to dry when the incision line is a good space above the septum. When the incision line is close to the septum, pulled some of the strip away to get to clear skin for port access for cleaning and accessing.
Certainly we do not want to disrupt the incision line because it has not completely healed.
Should we be cleaning over the steri strips? What should we be doing when the port is needed before 7 days and the steri strips can be removed without potentially disrupting the incision? The most recent event was a patient that went 3 days post insertion to one of our outpatient imaging centers. He was not happy that a peripheral IV was placed and his port was not used because the nurse did not feel the area covered with steri strips be disrupted for fear of infection and disruption of the suture line.
Thoughts??
The entire surface area of the skin must be cleaned before accessing the port using aspectic technique. I would take this issue to the appropriate medical committee within your facility - surgical or radiology, whatever. If you cannot go directly to a medical committee for political reasons, then take this to your quality improvement, risk management and/or infection prevention committee. Work in collaboration with them to apporach the physicians about this problem and get them to alter their practices with these wound closure strips. It might be possible to limit their use by using surgical skin glue or changing the way they apply the strips or altering the location for the incision. Nurses must step up to the plate, and expect collaborative practice on issues such as this. We can not fix all patient care issues without the help of other professionals involved nor should we be expected to do so. We should all be in the same game of patient care and its improvement. So changing the practices that prevent proper skin antisepsis and reducing the risk of opening the incision are critical issues that should involve a collaborative approach. 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
Hi All,
Lynn I completely agree that nurses should practice to the fullest extent of their specialty, stepping up within their organization to make change for best practice.
I am also seeing more use of steri stips under SVAP dressings. I'm considering this practice similar to gauze placement practice (CDC, 2011). Agreed?
What is SVAP? The issue with steristrips or any form of sterile tape under a transparent dressing is not one of infection but one of catheter stabilization. These strips do not adhere to the catheter, allowing it to freely move and become dislodged. So they are not appropriate for any type of plastic catheter. 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