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Kevin Travis Flint
Bedsie Central Line Insertion

Do your facilities have a policy in place that specifically addresses the issue of the nurse assisting the physicians during the central line placement at the bedside (triple lumen subclavian), donning sterile attire?  The issue has come up that the nurse often places the caps on the lumens using sterile gloves but is not donned in gown etc.  All input welcome.

 

Kevin

lynncrni
The nurse assisting is not

The nurse assisting is not required to be in sterile attire. Their primary purpose is to set up the field and assist the patient for positioning, anxiety, etc. Can't do all of that so easy when in sterile gloves, etc. Why does the nurse have to put on these caps? It seems ridiculous to me when the physician is already in sterile gown and gloves and can easily luer lock them on to each lumen. The nurse in sterile attire will only add to the cost without adding much benefit. If the docs will not cooperate with putting these one, then how do they prevent air emboli through these open lumens? Seems like a big risk to me and one that is costly and unnecessary. If they are clamping the line then they could just as easily screw on the caps. The only reason for using sterile technique for this step would be if the sterile field has not been broken. We remove and add caps without sterile technique after the catheter is inserted by using a clean, no-touch technique and no sterile gloves. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kevin Travis Flint
My thinking was focused on

My thinking was focused on those situations when the MD inserting the triple lumen runs into difficulty and needs the nurse assisting to help, shouldn't he/she be donned in sterile attire?  This entire CMS central line infection nonreimbursement has me thinking from every avenue to prevent infection.

Call me paranoid...........

Kevin

lynncrni
I guess it would depend upon

I guess it would depend upon the type of trouble presented. I can not think of a time when I have been assisting with such a procedure that the inserter needed a second pair of sterile hands. On the other hand, as the inserter I have seen many times when the patient required something that I as the sterile person could not do for them - nausea and vomiting, repositioning the arm or head, opening additional supplies if I dropped something. Just a few reasons why the assistant may need to break that sterile attire if they put it on.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wendy Erickson RN
The "100,000 Lives Campaign"

The "100,000 Lives Campaign" from the Institute for Health Care Improvement Central Line Bundle states:

For the operator placing the central line and for those assisting in the procedure,(my emphasis) maximal barrier precautions means strict complicance with hand hygiene and wearing a cap, mask, sterile gown and gloves.

If the assisting nurse is at the bedside "setting up the field and assisting the patient for positioning, anxiety, etc.", they must be in maximal sterile barriers.  How is this any different than with a PICC insertion where our assistant is required to be in maximal sterile barriers?  The assistant is not directly involved in the insertion and therefore may end up less than sterile, as when they apply a tourniquet.  But they still must be garbed in sterile barriers.

Wendy Erickson RN
Eau Claire WI

lynncrni
Well I guess I am thinking

Well I guess I am thinking of 2 separate people. An assistant to the inserter directly involved in the insertion procedure and an assistant to the patient for any special needs. I have never worked in a situation where we had the luxury of having a bedside procedure performed with the inserter (be they MD or RN) and an assistant both in sterile barrier. When I think of an assistant in these bedside procedures, I am thinking of the equivalent to a circulating nurse, dropping items on to the sterile field, moving the patient, etc. She has a mask on but is not in sterile gown or gloves.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kevin Travis Flint
Thanks Wendy, I thought it

Thanks Wendy, I thought it only made sense that those involved in this procedure be in maximun barrier protection.

I am mainly thinking of when the physicians are inserting the bedside triple lumen subclavians, but would think this applies to any sterile field laid out on the patient and at bedside.

Kevin

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