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JenMcCord
PICC Sterile Field set-up

Does anyone have anecdotal or clinical support for sterile field set up for PICC insertion at the bedside with either the inserter being hip to hip or hip to shoulder with the patient?  Just having some discussions here and the team seems split over this. 

My desire is for control of sharps and always having full visualization of the field during insertion.

 

Thanks,

 

Jennifer

lynncrni
In my experience, both

In my experience, both clinical and education, there are so many differences in the size, layout, and structure of rooms where a PICC can be placed. Given this vast difference, I have never seen any discussion of the where the inserter is standing with regard to the sterile field. The inserter is usually standing in front of the patient's arm which is outstretched at a 90 degree angle. Space dictates where the bedside table with the sterile field is actually set up. Even in a regular size hospital room, this table is usually behind the inserter simply because there is not enough space for it to be in any other location.  

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

Tim
I always set up my tray and

I always set up my tray and field the same way, almost almost always on the pts right.  I use an overbed table, with a bath blanket to cushion the arm.  The arm is at about a 45 degree angle from the body, with the US in the angle formed by the table and the bed.  I stand on the other side of the overbed table, near the pts R shoulder.  I hold the probe in my L hand, and the needle in my R, and I am looking directly at the arm, and just beyond that at the US screen.

Tim

Karen Day
Karen Day's picture
We place our piccs the same

We place our piccs the same way tim mentioned.  When we place a picc in the patient's right arm (which is the majority), we place our machine in front of us next to the patients rib and we stand at the head, therefore our entire field is in front of us and not hidden behind us.  When placing a left arm picc, we place our ultrasound machine at the patients head and stand next to their left side again with the table in front of us.  Both of our team members are right handed, if either of us were left handed - the set up would be just the opposite for each extremity.  We find this set up very useful in that all of our supplies are directly within our reach without us having to turn around to grab an item.

Karen

 

Robbin George
Where is the sterile field
Where is the sterile field set up in this configuration if the operator is standing at the head of the bed with the patient's arm and US device in front of you?--Do you need 2 bedside tables?--one to support the arm and one to hold the insertion materials?

Robbin George RN VA-BC

mary ann ferrannini
 You can also look up the
 You can also look up the basic principles of setting up a sterile field in a surgical/OR book. That is what I did and every once in a whileI post some tips in our office.
kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

I think out of all of this discussion the most important point I read was you can never turn you back or side to the patient.  Sterility is the front of the gown only and not below the waist to my knowledge.  Correct me if I am mistaken. that means you cannot turn sideways or backwards in the field and must have the front of the gown facing the field at all times.  If I remember my OR training it is only the very front chest area of the gown that is considered sterile.

Correct me if I am wrong.  That is the reason for the full barrier push.

Kathy Kokotis

 

Kathy Kokotis

Bard Access Systems

Karen Day
Karen Day's picture
Robbin, No we do not need

Robbin,

No we do not need two tables.  We placed the patients arm at a 90 degree angle and there is still plenty of room to place our tray on the right hand side of the table.  We use a full barrier drape and evey use 4 additional sterile towels to drape around the head, neck and shoulder area giving us more sterile room.  It is very easy and very sterile.  We have had virtually no infections related to insertion and we are at virtually no CRBSI's from PICC lines.

 

momdogz
It might be easier to

It might be easier to actually visualize how everyone sets up their field than write about it (how about posting some photos in the gallery?), but I'll take a stab at our "style": 

Constantly maintain sterile consciousness:

where are your arms/sleeves/hands?

where is your gown (be sure it's tied so it doesn't drag)?

where are the edges of all of your sterile boundaries? Keep yourself and your instruments away from these boundaries. 

get low hanging things out of the area (patient lamps, strings from fans, etc.) 

Always be able to visualize your sterile field. 

Waist down and your back is non-sterile.

Don't turn your back on sterile field.  If you do this, or leave the procedure area, you should no longer consider the field sterile.

Keep the ultrasound machine on the other side of the bed (unless you're able to drape the entire machine sterilely).  We stand in between the patient and the patient's arm, with our sterile field immediately to the left or right (depending on which are we're working with).  We're able to do this even with some very small procedure areas. 

Immediately remove sharps from the patient area (i.e. the bed) as soon as you're finished with them.  I keep all of my sharps well organized in the same area on the sterile field. We use a sharps checklist at the beginning and end of each procedure (2 people visualizing and counting).  This checklist is part of the patient's record.  Sharps include the catheter stylet, microintroducer guidewire, all needles, glass vial tops and bottoms, and microintroducer. 

Most of us have the patient's arm between 45-90 degrees depending on several factors, including the patient's ability to abduct their arm.  Most of the time it's less than 90 degrees.  The angle/manner you measure is important - it's been shown that the catheter will move ~ 2cm or more with abduction/adduction.   

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

momdogz
re-reading my post:  I need

re-reading my post:  I need to clarify that in several places I should have used the phrase "sterile procedure table" instead of sterile field.  Everything around me is sterile.  My sharps stay on the procedure table (not on the sterile drape over the patient), with all of my other implements.  Scissors also go on the sharps checklist. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

APIC organization (assoc. for infection control practitioners) put out a nice video on sterile technique in placing PICC lines last year

kathy

Kathy Kokotis

Bard Access Systems

Mercedes M
APIC

Can you post the web page or contact for APIC.  Thanks.

 

Mercedes McCoy, CRNI

Mats Stromberg
If anyone would post a photo

If anyone would post a photo of their setup, that would be really interesting. Probably there is a lot to learn from seeing how you guys do it. A picture says more than a thousand words, you know.

Mats 

Robbin George
Kathy--I searched for the

Kathy--I searched for the video you referred to and was unable to locate it--Can you please provide a link so we can view the video

Thank You

Robbin George RN VA-BC

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