I've always thought it odd that the INS standard for removing the statlock from a PICC is done with the same pair of gloves that are worn to remove the outer dressing. After removing the outer dressing that has been on for a week and living in a very sweaty (armpit) area, it seems to be that we would be introducing MORE germs to the insertion area (even though we will be cleaning the area afterwards). Shouldn't we be donning new clean gloves before the statlock is removed, or even removing the statlock as part of the sterile dressing change?
The PICC insertion site should not be in the armpit. It should be mid-bicep area, which is dry skin and not wet skin. Skin is never sterile, regardless of how well you scrub it or the antiseptic solutions used. So all old dressings and adhesive stabilization devices are removed with clean gloves. Then those gloves are removed and sterile gloves are used to apply skin antiseptic, skin barrier, adhesive stabilization and dressing. There is no evidence that this process increases risk of CLABSI or CRBSI.
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
Thanks, Lynn. As I home health nurse, i see some pretty disgusting dressings (patients are seen only weekly for dressing changes). Many of our patients continue to work (against our advice) as roofers and landscapers and have sweaty and soiled dressings. I'm glad to hear there is no evidence that I need to change into clean gloves before removing the securment device. But, considering how filthy the outer dressings can be, I don't think it will hurt to change my gloves after I remove the outer dressing and before I removed the statlock. Thanks for your input.
AAL RN, Vermont
Of course each situation may require some differences. As you mentioned when the outer dressing is so very dirty, a change of clean gloves may be best to remove the adhesive securement device. Nothing wrong with that just not required for every situation. 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