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Gina Ward
What is your hospitals process for Midlines/ PICCs in the below mentioned areas?

 

 

1.   Do you obtain consents for the insertion of a Midline in your facility?    ( we currently do not) 

2.  Do you do a "time out" prior to the insertion of a Midline?  ( we currently do not, only for a PICC line)

3.  Do you utilize maximum barrier precautions for insertion of a Midline?    ( we use the modified barrier precautions with drape under and over arm, hair cover, mask and sterile gloves, and sterile probe cover )

4.  Do you have a 2nd person observe all your PICC line insertions and check you off on a insertion checklist saying you adhered to the insertion bundles, maintained sterility etc. ?

( we do not, we have periodic observations as a part of a perfomance improvment /IF data collection )

5.  Do you do a 3 minute scrub of your hands and arms prior to each line insertion ?

 

Looking forward to your responses,  thanks in advance, 

Gina Ward RN, VA-BC

    

 

JackDCD
Wow Gina!.....that must make

Wow Gina!.....that must make a Midline a bigger deal...lol

1. no

2. we do, but I'm not sure why

3.Yes...however, I understand that ACCU-Caths do not require full barrier

4. No...

5. No...why are you doing that instead of Purell? 

Gina Ward
Jack,

Jack,

thanks for your responses.

When you say Purell are you referring to the Hand Sanitizer?  Yes, we utilize ( different brand) and its actually on our cart.  However I have been reading and found noted in several articles use of a 3 minute scrub , similiar to a surgical scrub,  prior to each insertion. 

thanks again, Gina

 

 

Gina Ward R.N., VA-BC

lynncrni
The observer is not for the

The observer is not for the purpose of assessing performance or competency. It is to closely observe the steps done on each patient and procedure to make sure there was no breach and every step was done correctly. This observer is empowered to stop the procedure if a problem is identified. The inserter can NOT accomplish this observation and complete the checklist alone. Just not possible. 

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

Gina Ward
 Lynn  thanks for your

 Lynn  thanks for your response,

Yes, that is what I meant...  monitoring for adherence and sterility. .  I may not have worded my question that way though. ( i edited it)

I guess my ultimate question is;  Is that required, an observer , who is ensuring adherent to proper technique and completing the checklist accordingly?   

I see it listed in the INS standards , and it  says  SHOULD.   I am not arguing the point of the situation just must it absolutley be done?   Is it a mandate by Joint Commission?     I remember reading long ago a post where someone specifically asked JCAHO if they must always have someone in during insertion to monitor for adherence and the answer was no.    I think i found it here, on this list serve.  But.......it was way back in 2009.

I guess I just need and absolute YES or NO . 

  then....  I can work agressivley at making a plan to make that happen with my leaders. .   Most likely it would have to be the pts nurse do the observing, as we can not staff 2 FT nurses or employees each day on our team.   I also realize that most of the nurses would never even recognize a breach in sterile techinque . they would require additional training.    I rarely see them manage anything steriley where they dont contaminate something and they dont even know it. 

Thank you in advance for your response,  Gina

     

 

Gina Ward R.N., VA-BC

lynncrni
Standards and guidelines are

Standards and guidelines are not required or mandated. they do not have the force of a law. Compliance with any of them - CDC, SHEA, APIC, INS, CDC, ONS, ASPEN, etc - all voluntary. CDC, INS, SHEA, APIC all recommend the empowered observer. But again, all these documents are voluntary compliance. This person does not have to be an RN, or another infusion/VA staff. Many teams are very successful with hiring CMAs or some other type of technician and training them extensively. They act as the empowered observer to stop the procedure if something is noticed and to assist patient and inserter during the procedure. You will not find anything mandating any statement in any of these documents. So why are you using any of these document contents? Cherry-picking what parts the hospital will and will not accept has always been odd to me. Documents from regulatory organizations such as OSHA, CMS, and your board of nursing are required, but not the others. 

 

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

Gina Ward
Thank you for your response.

Thank you for your response.

That statement about "cherry picking" really hit home and made sense.  

In regards to standards and regulations being mandated;   your explanation helps clear things up;   not mandated by law but recommended.   So maybe its not the law I am worried about but say Joint Commission comes in and observes and we dont have an observermonitoring the insertion and completing a checklist.  Us, not adhereing to their recommendations may reflect negatively on their evaluation of us and we may be marked as non compliant.     They wont say,  " oh thats ok, some hospitals do that and some dont its whatever your facility has decided".    They will say we are non compliant with their standards.

 

 

Gina Ward R.N., VA-BC

lynncrni
From what I have read of TJC

From what I have read of TJC standards, they are not worded in such a manner to be prescriptive about actual steps. They are written in very broad terms and it might be the way your surveryor applies the statement. Several years ago, TJC did write a large resource on CLABSI and they do endorse the SHEA Compendium which includes the empowered observer. So what you think is possible to happen. I would locate the Comprehensive Accreditation Manual for Hospitals for 2019 and read the section on infection prevention. Also consult with your IP dept. 

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

JEE9890
   1. No consent for midlines

   1. No consent for midlines

    2. Yes to time out,  we have a "work up" form we use for midlines and have a spot for time out.

    3. We use Bard Powermidlines and there are  maximum barrier precautions in the kit, or we drop on probe cover etc.

    4. Always 2 staff for PICCs and Powermidlines.  No "central line audit" for midlines, but 2 staff.

    5. 2 minute scrub prior to both insertions.

Gina Ward
JEE9890

JEE9890

Thanks for your responses.

We also use Bard Power midline  PRO, the full kit and it does not contain everything you need for Maximum barrier precautions.  Do you add in the other items?  sterile gown, 3/4 drape?  or are you saying you use the small drapes provided in the kit because they dont consitute Maximum barrier precautions.    

thanks again,   Gina

Gina Ward R.N., VA-BC

JEE9890
Our PowerMidline kit has the

Our PowerMidline kit has the full body fenestrated drape.  We drop on other things such as 96"probe cover, another CHG 3 ml swab for after insertion prior to the tegaderm, chg disc, and microclave.  And I always have a second person for the procedure, somtimes it is so needed when we place the full body drape on, along with the help if needed to maintain sterility.

Gina Ward
Wow,  I honestly looked at

Wow,  I honestly looked at all the packaging  for the Bard powerglides and did not find one that has a full body drape.

What is the item number if you dont mind sharing it with me?  We may need to move forward and do that so that would be helpful.

Thanks again for your response,  Gina

 

Gina Ward R.N., VA-BC

JEE9890
The kit # is P4154108D. 

The kit # is P4154108D. 

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