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Robbin George
INS Standard #49-III/IV "Catheter Removal-PICC Nontunneled CC"

Standard 49 III (PICC) IV (Nontunneled CC) Practice Criteria Item G does not designate removal of these CVCs as a sterile procedure but a colleague who is preparing for the CRNI exam is confused as to the language that states "Digital pressure should be appled until hemostasis is achieved, then antiseptic ointment and a sterile occlusive dressing should be applied to the access site"--Could someone please qualify the terms STERILE and OCCLUSIVE as used in these statements--We have been using vaselline gauze covered with a 2X2 (some pt are allergic to antiseptic ointments) and tape--Thank you in advance of your responses

lynncrni
This means that the dressing

This means that the dressing left remaining on the insertion site of any removed CVC should be one that adequately seals off the skin-to-vein tract. This is accomplished with a petroleum-based ointment and a dressing. Neither a TSM nor gauze and tape would prevent air from being pulled into this tract. The ointment seals off this tract while it epithelizes. This prevents dangerous air emboli! 

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

Robbin George
What about the term
What about the term STERILE--Is removal of a CVC necessarily a sterile procedure if you not cultureing the tip?--Should we be following the same guidelines when removing a CVC as are used for CVC drsg change (ie mask and sterile gloves)?--The INS standard does not include this statement

Robbin George RN VA-BC

lynncrni
I have never used a sterile

I have never used a sterile procedure to remove a CVC even when I was taking a culture of the tip. The external catheter that you are touching was only sterile when it was removed from the package. When removed the sterility of the external part is long gone. You can remove this with clean gloves and still use sterile scissors to amputate the tip into a sterile cup with a no-touch technique.

For the dressing on removal, this is the same as any dressing. CDC guidelines state you can use clean or sterile gloves to change the dressing. It would require use of a no-touch method of squeezing the ointment from a foil package directly to the site and them application of a dressing that has paper tabs for holding and not- touching the adhesive part. It is often easier to use sterile gloves when the available supplies do not allow for this no touch technique.  

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

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