Aloha All !
We are searching for a new product for us - an all inclusive IV Insertion Kit for nursing to use at the bedside in an acute care setting (includes Oncology, several ICU, Pre-surgery, Med-Surg, PACU and a few outpatient clinics). The committee looking at the selections and contents has asked for information regarding use of a drape as a common piece for the kit. Most kits do not carry a drape, I have heard? If in the kit the drape would be as sterile as all other components. Is this desired or not?
What is recommended by the literature (?) in regards to drapes used for peripheral IV starts? Is there evidence that indicates a drape is not necessary to keep the procedure risk free during a bedside insertion? Will we save money by eliminating the "sterile drape" from the kit and still maintain a risk free aseptic zone on the bed for the insertion procedure? Is a "No-Drape insertion" common? Is a non-sterile absorbent drape used commonly? Is a paper towel the common practice for draping? What is the recommendation for "best practice"? (...and what do we use for Central line dressings or Foley insertions?)
Thanks for you answers. I am hoping to hear from INS on their position as well as any "evidence based" comments.
We discontinued IV kits for peripheral IV starts more than a decade ago. We do have a sterile kit for central line dressing changes and Port Access. Our PICC lines are placed using kits specifically designed for us including full body drape, gloves, masks, hats, etc. For recommendations and guidelines, I always refer to INS and the CDC. The CDC published a position paper entitled "Guidelines for the Prevention of Intravascular Catheter- Related Complications. It covers all types of lines and their recommendations for the placement and care of each. www.cdc.gov They also have recommendations for all Hospital Acquired Infections. I hope this helps you a bit.
Kim Mills
Cumberland, Md
Without a start kit for peripheral catheters, I would be extremely concerned about the following:
nurses time to gather all supplies and take to the room
nurses forgetting to obtain one or more important pieces for the entire procedure, thinking I can do without it and compromising the aseptic technique in the process
nurses forgetting and requiring additional time to obtain what was forgotten
All of this can be made much safer for the patient and easier for the nurse and more cost effective for the hospital when start kits are used.
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
Depending on the unit, some use IV trays with all the needed items that you can either take to the bedside or pick and go, or as in Same Day Surgery - where IV's are plentiful - they create "sets" in the med room with the components - the nurse goes in, grabs and goes. I have seen no difference in the infection rate since our change and it certainly saved us a great deal of money. AND this only pertains to peripherals - we do have kits for central line dressing changes and port access kits - those are complete and sterile. We just saw no need for a kit with a tourniquet, 2X2, dressing and cleansing swab.
Who is responsible for cleaning those trays and on what frequency? If that has escaped your infection preventionist, I am very surprised. 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
According to our Preventionist it is cleaned and restocked at least 3 x's weekly and they have performed random cultures to insure cleanliness.
I still work bedside at times. On one busy telemetry unit I purchased a shower caddy to use for iv supplies and stocked it. Every time I came back to the unit I cleaned it myself, and let me tell you that thing got nasty - used catheters stuck to dirty old used dressings, dirty strips of tape, new cannulas opened and returned to be used, drops of blood, plain old trash, you name it. The supply tray definitely needs a designated cleaning and stocking schedule along with rules about placing on the patients' bed or overbed table.
On the flip side, I've worked on units with iv kits and have witnessed nurses opening a kit just for the tape, or the tegederm. I've seen them open several kits for one piv as though cost is of no concern.
As far as a sterile drape, my favorite is the small moisture barrier drape in the kit. It is sterile but my clean gloved hands are not so as soon as I pick it up sterility is gone.
Thanks Jill, KIm and Lynn for your comments...
I need confirmation that a drape is desired by experts who place IV's. sterile or not ...is a drape important? Is in the kit better than not used? Could use your help here...thanks.
Scott
Scott Gilbert RN, VA-BC, MPH
Honolulu,
Thanks Jill, KIm and Lynn for your comments...
I need confirmation that a drape is desired by experts who place IV's. sterile or not ...is a drape important? Is in the kit better than not used? Could use your help here...thanks.
Scott
Scott Gilbert RN, VA-BC, MPH
Honolulu,
Thanks Jill, KIm and Lynn for your comments...
I need confirmation that a drape is desired by experts who place IV's. sterile or not ...is a drape important? Is in the kit better than not used? Could use your help here...thanks.
Scott
Scott Gilbert RN, VA-BC, MPH
Honolulu,
In 2012, This literatur review was published:
1. Hadaway L. Short peripheral intravenous catheters and infection. Journal of Infusion Nursing. 2012;35(4):230-240.
This was a literature review of all types of studies, 1400 abstracts review, 588 studies read, 45 studies included. There was no mention of using any type of drape for insertion of a PIV, however many of those studies did not provide information about skin antisepsis, use of gloves, or type of securement or dressing used. So there is definitely a lack of information about infection in PIVs. Traditionally, I have never used a drape to do this procedure. There has been a recent change though. CDC and INS now both state that palpation of the site after application of skin antisepsis requires use of sterile gloves. But even the Association for Safe Aseptic Practices out of England is not recommended a sterile drape for PIV insertion to my knowledge. I have used a large paper towel to place under the arm to collect the package trash as you open it and to protect blood from reaching the sheets, but this was not a sterile drape. So in my opinion, the need for a sterile drape for insertion of a PIV is an unresolved issued. Chances are it will not be resolved anytime soon either, as CDC only requires data collection on CVADs and only for bloodstream infection. 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
Thank you Lynn, I appreciate your comments and I agree that no research will be conducted to evaluate such a minor draping issue. But it was asked if evidence either way existed. I wondered what expert opinion would reveal.
Thank you.
Scott Gilbert RN, VA-BC, MPH
Honolulu,
I guess my opinion would be that it might be a good idea, but with the number of PIVs inserted and the lack of evidence, you would have lots of trouble getting this practice to change. If we could just get good site selection, hand hygiene, and skin antisepsis, that would be a giant step. 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