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ivtherapy
Catheter advancement

I need your help.  I am having to testify at a hearing regarding a terminated employee.  I need opinions to the following:

A PICC is placed and some catheter is left external.  The catheter is dressed, x-ray taken and resulted as not SVC.  Would you remove the dressing and advance the portion of catheter that was left external.  This catheter was not wrapped in sterile towels.

Give me your practices.  If you have any references please include.  Thanks.

IV Therapy

lynncrni
Absolutely no, never, ever
Absolutely no, never, ever advance any external portion of any catheter that has been in contact with the skin! During the insertion procedure, the skin is cleaned with an antiseptic solution, however skin can never be made sterile. Once the catheter is stabilized and dressed, it is in contact with skin that will always be shedding skin cells and this also means that microorganisms lying deep with the epidermis will move to the skin surface. The only method for getting this catheter into the proper SVC tip location would be to do an overwire exchange. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

clhunchusky
Lynn, Can you reference any
Lynn, Can you reference any articles or studies related to this topic? Thanks, Cindy
lynncrni
This is based on basic
This is based on basic anatomy and microbiology of the skin. So any A&P textbook will support. Since we know this information about the skin, it would be considered unethical to conduct a research study where catheters in contact with skin after the sterile field was broken to be reinserted. So, no, I cannot quote a specific study, but to expect this sort of study is not realistic, in my opinion. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

gretchen
NO! Gretchen

NO!

Gretchen

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems 

No!!!  I practiced Infection control for four years in Chicago.  I do not believe in wrapping an arm in sterile towels and even going back into a so called sterile field.  Bowel surgeons never do that.  Ever see a doctor do that with a central line placement?

Kathy Kokotis

Bard Access Systems

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