In our outpatient infusion center we are often called upon to do weekly PICC care and maintenance for home infusion patients. These are patients who have been opened to home care and educated on home infusion and administration by a home care nurse. After the initial start of care and education, if the patient is not homebound, they are discharged from home care nursing but continue to receive their IV medications from a home care pharmacy. My outpatient facility provides weekly PICC care for the duration of treatment for these infusion patients. For many of these patients, on the initial visit to my facility, we find that the home care nurse has added tape around the base of the needleless connector and at the junction of any add on extension tubing as added securement. The tape is often dirty and when removed, leaves a very sticky residue that must be cleaned. Once removed, we do not replace the tape to these connection junctions however, patients have been taught to keep the tape in place. I have searched the literature as well as the INS standards and see no reference to the use of tape at these connectors. My greatest concern is an increased risk of CRBSI with the soiled tape and sticky residue at the base of the needless connector and extension tubing. Is this common practice among home care infusion patients? Is there any evidence to support or negate the use of tape at these connection sites? Thank you
Clinical judgment is still a powerful tool for nurses! I don't know of any evidenced based practice on this particular subject but common sense is all we really need! I think I recall a study that demonstrated MRSA presence on hospital bed rails AFTER they had been cleaned, and that tape residue was the main culprit.
The simple questions here are....Is it easier to clean my connection protecting the sterile fluid pathway when it has tape residue? Or without tape residue? Does the tape function to protect the patient? Or to make the home care nurse feel more secure?
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Their main purpose in using the tape is tubing junction securement. While I can understand their concern, tape will leave this residue and allow it to trap more microorganisms from the environment. A previous edition of the INS standard stated that tape should not be used for junction securement. The new edition of the standards states in many places that all junctions on the whole system must be luer-locked. There is no evidence that tape provides any additional securement and there is the concern about increased infection risks. So I would educate this company about these risks and try to gain their cooperation to change their practice. 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