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Ryka
Line Contamination

I am looking for a consensus regarding possible contamination of a central line. If a patient has a tunneled line (PICC or Dialysis catheter specifically) and the patient is found with the dressing off, would  you consider this line contaminated and recommend removal? These lines are sutured in place, and glue is placed over the insertion site to occlude the entry point. Many of these patients who have a long- term tunneled line do not use dressings when they are home. While we do prefer to cover the site during hospitalization, some patients remove the dressings during the night. Normally, we would consider any exposed line contaminated, but since there is occlusive glue applied to the site during insertion the entry point is sealed.  I would appreciate any feedback regarding practices at your hospital for this population of patients.

lynncrni
NO. Even if the glue is not

NO. Even if the glue is not used, I would not consider this line to be contaminated to the point it needs to be removed if the only problem is the dressing removal. Skin is never sterile, so once that external catheter has contacted skin, sterility is over. I would aseptically clean the site with alcohol, then use skin antiseptic such as CHG, reapply dressing and securement, document and observe. Do these tunneled catheters also have a subcutaneous cuff? If so, that is another barrier to skin organisms reaching the bloodstream and more reason to not remove it immediately. Even if there is no cuff, I would not remove it immediately. Dressing interruption alone is not a valid clinical indicator to immediately remove the CVAD. It is a valid reason to careful observe patient, educate about elevated temps, and any change in how they feel, etc. 

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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