Thank you Lynn, THAT is what I was looking for. However, the
discussion seems to have taken a fork somewhere. The initial
question
was a line that was pulled out and a few people were referring to
repositioning a line that was malpositioned. Of course, if a line is
pulled out by accident, it would never be reinserted. I wasn't
saying
we reinsert in that situation and I apologize for my misunderstanding
the initial post due to some of the other posts that followed.
What I was asking was repositioning a line that is malpositioned
(i.e., jugular, etc.) We do not presently have a navigator system
as our PICC team is relatively new and that is among the many things
we are researching and begging for. We utilize several tricks we
have learned from those more experienced to avoid malposition, but
since the human body is NOT an exact science, there will always be
exceptions. In this case, what is the protocol?
K. Pater, RN
--- In [EMAIL PROTECTED], Lynn Hadaway <[EMAIL PROTECTED]> wrote:
I was agreeing with you up until your statement about sterile
site,
sterile catheter, sterile dressing, etc. The skin can never be
made
sterile. This is proven fact. The best agents and techniques will
only remove about 80% of organisms leaving the remaining 20% which
will be located deep in the epidermis near glands and hair
follicles.
As the epidermis cells shed, new cells and these organisms rise to
the surface. The catheter is lying on top of the skin. The
external
portion can never be made sterile again while a portion is still
in
the patient. No amount of scrubbing or agent application will
render
the catheter sterile again. The catheter is only sterile when it
is
removed from the packaging.
I would agree that we do not know the risk of infection associated
with exchange procedures. This needs to be reported by someone
tracking this data.
But reinsertion of a dislodged catheter has never been accepted
practice in my 30+ years. No one has ever studied it to my
knowledge, probably because we know the how organisms on and in
the
skin behave. So there are no published statements about this but I
submit it is because this is such a basic concept that would have
ethical issues if anyone tried to study the reinsertion of a
dislodged catheter. Can you imagine any patient agreeing to have
the
catheter cleaned and reinserted after all the risk have been
explained? This would be required for such a study due to informed
consent requirements. Such as study would never make it past an
IRB.
Lynn
At 3:27 PM +0000 9/20/06, kam_eap wrote:
You know, we reposition according to our P&P that is handed down
from our larger sister hospital, not because we're bad nurses. We
are constantly trying to gather information that will help us
improve our practice. We are continuously researching and trying
new techniques in hopes of reaching 100% success. >It seems that
repositioning vs. exchange is definitely a
controversial topic, and I'm guessing this is because there isn't
a
set standard? I would much rather hear the INS/AVA standards and
reasoning than the soapbox lectures and insults. >Personally, I
don't see how an exchange is any more sterile than >repositioning.
Why? Sure, you have a sterile catheter, but the >insertion site
obviously won't be sterile if you use the same >reasoning that the
initial line won't be sterile. If the site is >sterile during the
initial insertion and it is kept sterile and a >sterile occlusive
dressing is applied, with any outside catheter >contained under
said
sterile occlusive dressing, then one would >think it would still be
sterile. >I'm not taking a stance on this one, because I joined
this
group
to
learn and realize that, as a nurse, I will NEVER have all of the
answers. It is my job to continue to improve my practice for the
good of my patients. We take all things into consideration when
dealing with placement issues, because there is no perfect answer
that will work in every case, with every patient. >We look at the
big picture and consider what is best for the
patient.
Can anyone cite specific standards from INS, AVA, NIH, or CDC
regarding this topic? >
K. Pater, RN
--- In [EMAIL PROTECTED], rkg50@ wrote:
What the "PICC" nurse should have done is an EXCHANGE--Sterile
procedure with a new catheter
--
Robbin K. George RN
Vascular Access Resource
Alexandria Hospital Virginia
rkg50@
-------------- Original message --------------
From: Doug Buehrle <dbuehrle@>
It is totally innappropriate to reinsert a line once it is
pulled
out. Cleaning it is not the answer. With Blood stream infections
having a 25% mortality rate I think this nurse should go back to
school on that one. >> Doug
Mary <musicfae@> wrote:
I was asked a question recently about lines that have been
pulled
out.
This PICC was pulled out 10cm and the PICC nurse cleaned the
area
and
reinserted the line. Then checked with CXR for placement. Is
this
an
appropriate thing to do with that much line contaminated? Are
there >> standards set by INS to address this? Thanks everybody
for >responding.
M.Moore,RN
PICC Team
Ft Worth
Douglas Buehrle RN CEO
Triangle Vascular Access Professionals Inc.
Offices in Nebraska and North Carolina
16 Briarfield Ct
Durham, NC 27713
(919) 321 6105 office
(919) 215 6957 cell
You can trust TVAP with all your vascular access needs.
[Non-text portions of this message have been removed]
[Non-text portions of this message have been removed]
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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
MedComp Proud Sponsor of the Vascular List Serve.
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