I realize that home care nurses are in a different situation than
nurses in the hospital. Hospitals have policies and procedures
established and physicians can not arbitrarily alter them for his or
her patients alone. Home care companies do not wish to antagonize the
physicians fearing that the referrals will stop. But there comes a
point where the nurse must advocate for safe practice and refuse to
do something that is so far outside the standards and manufacturer
instructions.
The skin can never be made sterile, ever. Regardless of how well the
skin prep was done, there will always be organisms residing in the
lower layers of the epidermis and around hair follicles and sweat
glands. As cells move to the surface, so do these organisms. So can
you imagine the sea of organisms that is created by all these TSMs on
the skin. Then the port needle is stuck through this. There is no way
I would ever do this regardless of where I was working. Lynn
At 9:11 PM -0700 3/1/06, Halle Utter wrote:
I saw this once also, with an added feature. It was at a University
hospital on the pediatric ward. I was doing home IV therapy at the
time, and the surgeon who placed the port had very specific
instructions about accessing the port through the TSM. But he
wanted a new TSM placed before or after every access. So they were
accessing through like 5or 6 TSMs when I saw it. I couldn't believe
it. I don't know the outcome as I was there to see another patient
and the nurses ask me about this. I told them I had never seen or
heard of it, (before or since, til now!) Sorry I don't know what
happened after.
Halle Utter RN, BSN
Denver, CO
PS This wasn't in Colorado by the way!
----- Original Message ----- From: "Fritz, Donna" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, March 01, 2006 9:04 AM
Subject: port access through TSM
I did see this once. A pt returned from the OR with newly placed,
accessed port. It had a not-very-esthetic gauze and tape dressing,
so we carefully removed the dressing so we could reprep and put a
TSM. Lo and behold, the TSM was on the patient, with the port
needle right through the TSM.
I think the issue of how to dress a newly placed port is important,
however. What I find frequently is that pt returns with
steri-strips covered by TSM WITHOUT needle access. Then we
(oncology nurses--usually me) have to remove part of the TSM,
enough to prep and access, but not pull the TSM off of the
steri-strips as strips cannot be removed from the TSM adhesive.
The use subcutaneous sutures with steri-strips for skin closure. I
might be in favor of a small piece of gauze put over the strips to
protect them from TSM adhesive for the first little while.
Donna Fritz, MN, RN, OCN
Oncology/Pain Clinical Nurse Specialist
Cancer Center
St. Mary-Corwin Medical Center
719.560-5215
[EMAIL PROTECTED]
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
