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Anne Marie Frey
Clean vs. sterile procedure for central line removal??

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. 

Thanks for any input....

Anne Marie

Anne Marie Frey, RN, BSN, CRNI

The Children's Hospital of Philadelphia

tereed
At Texas Children's Hospital
At Texas Children's Hospital we also use sterile technique.  We have the gel skin cleanser in our carts and near by so that we don't have to go all the way over to the sink to wash before placeing our sterile gloves.  If the line is getting pulled I am not sure sterile technique isnecessary as the ontment at the site should prevent any infections.  I agree that sometimes it is very difficult to change gloves with an active infant.  We have devised some creative mummy techniques!  Theresa Reed, RN, BSN
lynncrni
This process does not sound

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, 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

Anne Marie Frey
HOME CARE CAP CHANGE

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]

Glenda Dennis
We don't treat line removal
We don't treat line removal as a sterile procedure.  Washing hands and non-sterile gloves is what we use.  After the line is pulled, I apply a little pressure with my hand about 4-6 inches above the insertion site (in adults) while I apply the ointment at the site. Then I place the transparent membrane dressing to the area.  I have not had an infection or air embolism occur or using this technique.
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