We have recently found that some of our nurses are placing the biopatch on our ports and some are not. Our Lippincott policy does not state to place any type of CHG patch and I was wondering what the recommendation is. It seems that some of the nurses are placing it on the huber needle prior to sticking the patient. Others are placing it after accessing the pt.
Thanks,
Kim Springer
Educator
Here is a technique from BARD
http://www.bardaccess.com/assets/pdfs/other/MC-0471-00_SafeStep_PowerLoc_MAX_FAQ_web.pdf
Here is the statement from the 2011 CDC Guidelines:
Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age if the CLABSI rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorhexidine for skin antisepsis, and MSB [93, 96–98]. Category 1B
An implanted port is not considered to be a short term catheter and does have a very low rate of BSI. I would work with your infection prevention committee to determine if this patch is needed for implanted ports. Regardless of what you decide, the practice should be standardized with all nurses doing the same thing. There is no way to monitor outcomes when groups of nurses are doing their own thing.
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
We do if the port will require access for more than 24 hours....it is changed with the needle change every 7 days (if it remains accessed for that time).
When placing the biopatch on the huber needle prior to sticking...is this difficult to maintain sterile technque? Do you have difficulty securing the dressing -just curious.
There does not seem to be any trouble with sterile technique for the ones that are placing the biopatch on the needle prior to sticking but there is some quesiton to sterile technique if placed after it's stuck. No trouble with the dressing adhering. There is no consistency. We just recently went to having 2 pairs of sterile gloves in the pack due to our Lippincott policy requiring it. They recommend changing your first pair of sterile gloves after you have cleaned the site.
Our local hospital used to place the Biopatch under the port needle. They use the Gripper Plus needle which has a foam padding on it. They would send their chemotherapy patients home and then we would get phone calls from the patient stating that the pump kept beeping "down occlusion" or that their chest hurt. Upon assessment of the patient(s) we found several extravasations of 5FU because the nurse placing the gripper needle did not account for the additional height of the biopatch and the needle would move out of the port at some point and thus cause the extravasation. We documented everything and then met with the Oncology staff and told them of the issues. In some patients, a longer needle still would not have worked because of how deep the port had been placed. Because of the safety issues involved, they stopped placing the biopatch under the Gripper needle. I know there are other non-coring needles available that would work really well with the biopatch or whatever brand of antimicrobial disc used.
Marianne Valentine, RN, BSN, CRNI
PharmaCare Infusion Services, Cumberland, MD
Marianne Valentine, RN, BSN, CRNI
Nurse Manager
Pharmacare Infusion Services
Cumberland, MD
There are no actual studies showing that 2 pair of sterile gloves are necessary for any CVAD dressing change or port access. But, in my opinion, it is best practice. The gloves used to apply skin antiseptics could easily be contaminated and the needle must be sterile when it is inserted. 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
Since you may need to replace the biopatch, seems like you'd put it on last to assure it doesn't interupt needle function. This is assuming you think its needed for a properly functioning port septum.
Depending on the presentation of the I-Port....after I have prepped the skin and allowed to dry....I will place the CHG sponge on the skin (direct access site) and puncture through the center hole...please note that different port presentations at the skin level might reguire modifications to technique.