It is considered acceptable practice at our hospitals to utilize IR to reposition central lines if our PICC team is unable to advance the tip to the SVC. This is done only the same day of insertion or the next morning if it is too late for IR to add to their schedule. We have not seen any infections resulting from this practice of having them reposition/advance the line. I know the INS Standards state a line should never be advanced once it has had contact with the skin due to infection risk. My question is, is it acceptable to have IR manipulate the line within a 24 hour window of placing the line? Are there any studies that show the actual risk of bacterial growth on the line under the sterile dressing and with chlorahexidine used to clean before dressing and after removing the dressing prior to advancing/repositioning the line? In our adult hospitals, we only send to IR a few times a year since using ECG, but in our children's hospital, the practice is more common.
This practice means you are touching a contaminated catheter with sterile gloves and advancing it into the vein if the external catheter has been in contact with the patient's skin. Skin can never be rendered sterile regardless of agent or technique used. At best you will remove about 80% of organisms so any segment of the catheter in contact with skin will no longer be sterile. There is no time period when it is possible to advance the external catheter into the vein. This is the reason for the INS Standards statement. This is a basic infection prevention practice for any sterile procedure. At the very least you need to discuss your procedure with your infecton preventionist and get their feedback. 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