Somehow clinicians think that if the PIV is in only for a few hours, there is a lesser risk of infection. The risk occurs at the TIME OF INSERTION. Therefore any less stringent adherence to recommended practices, eg, inappropriate antiseptic application on the skin, use of non-sterile tape, etc can lead to peripheral site infections. The procedural folks don't see it, but it might be seen by the patient at home a few days later as a reddened tender site, or in the clinics.
The reason I say this is from two sources, although both are anecdotal, from nurse managers in my institution. One was the CNS on the CCU. He told me that the cardiologists were questioning what was happening with PIVs in CCU as they had a number of patients with "infected" PIV sites a week later in clinic. It may be a combination of the wrong drugs being infused peripherally and this was chemical phlebitis or poor insertion technique and true exit site infections. It was problematic enough for the docs to notice, report it to the CNS, and for him to ask me about it. I told him to try to see what drugs were infused through those PIVs, and th culprits might be irritating infusions. I also told him to review the PIV Procedure with the nursing staff and to remind them to use the PIV start kits which have the Chloraprep sepp for 30 seconds,
let it dry and to NOT touch the site with nonsterile gloves unless they cleaned the glove tip with extra chloraprep. The kits also have in it sterile tape, and a sterile transparent dressing. I told him to remind the staff to apply the sepp
The second report I got was from the Nurse Manager of Radiology. In the CT and MRI areas, they receive the inpatients with supposedly "patent" PIVs. A lot of those PIVs are dislodged or don't give blood return, but some of them also have "nasty" infections" at the exit site (her words, not mine). She is appalled that nurses allow that to happen and persist. In other words we have a LOT of work to do, because clinicians think "it's only a PIV," and become very cavalier with their insertion technique because they "don't see the infections."
Even a few infections every year on every nursing unit in a hospital are too many.
From: "Schwaner, Sandra L *HS" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: question abt outpt infusions
Date: Tue, 15 Aug 2006 15:03:13 -0400
>Listservers:
>I've just worked extensively with the practice council, procedure committee, procurement, center for organizational development and representatives of numerous pt care areas to develop a comprehensive IV care package. One of the procedures was on dressing IVs and specified that no unsterile tape was to be used, and that a sterile dressing needed to be applied. When this was questioned by the outpatient areas (Iv is only left in for 10 ments for photovoltaic therapy or ct or whatever), I reiterated the need for infection control, and for consistency....when you go to UVA and have your IV started, you can expect it to be started this way and dressed this way. I am now being asked for studies on infection rates in outpatient areas with nonsterile dressing practices......any suggestions?
>
>I believe strongly in evidence based practice, and try to practice what I preach.....but I'm feeling that common sense has left the building....
>
>
>Sandra L. Schwaner MSN, RN, ACNP
>P.O. Box 800377
>Angiography/ Interventional Radiology
>University of Vriginia
>Office: 434-924-9401 - 434-243-7081
>Fax: 434-982-6468
>Pager # 6180
>
>
