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Digital Issues

Archive >  May, 2014 XV, No. 5

Infection Prevention: How to Safely and Securely Tape an IV

The traditional crisscross taping pattern could be an infection risk.

Melissa Cady, DO

non-sterile tape INFECTION BREACH? Are you risking infection by using the same non-sterile tape rolls to secure catheters on patient after patient?

Could the rolls of tape that your anesthesia providers use to secure IVs cause infection? They might if your nurses or doctors routinely split 1-inch surgical tape in half, then apply the strips below the hub of a newly inserted peripheral catheter and secure it in a crisscross or chevron pattern. This common practice of using non-sterile tape rolls to secure peripheral catheters on multiple patients is an open invitation to cross-contamination, especially in immunocompromised patients and in those with long indwelling catheter times.

When I surveyed 200 hospital workers who start intravascular catheters, 67% reported that they initially used non-sterile tape on peripheral catheters, followed by sterile, transparent medical dressing over the catheter/tape apparatus. This raises a question: Why is non-sterile tape being used initially to secure a catheter hub at the patient's fresh puncture wound?

The traditional crisscross method isn't just time-consuming and obstructive, but if you use non-sterile tape and place it near the skin opening, the edges of the tape are a threat to introduce pathogens into the bloodstream (see my research on this). Here's a safer, better alternative your anesthesia providers will really appreciate:

Cover the IV with a Tegaderm dressing. After securing the IV catheter, apply a wide strip of sterile, transparent dressing (Tegaderm, for example) over the IV hub/connection to the tubing (Photo 1).

Tape parallel to the catheter. Apply a longer and narrower piece of any clear tape over and parallel to the IV catheter, with a small amount proximal to the Tegaderm and pinched onto the tubing at the distal end (Photo 2).

Tape perpendicular to the catheter. If needed, apply tape perpendicular to the catheter to help prevent the tubing from flipping the catheter up and out.

DO THIS:

wide strip of sterile 1. Start with a wide strip of sterile, transparent dressing.
second piece of tape 2. Apply the second piece of tape parallel to the catheter and proximal to the Tegaderm.

Improved sterility, stability and visibility
The traditional method of placing sterile transparent dressing over the crisscrossed tape (Photo 3) makes it hard to troubleshoot a kinked catheter or to remove taping when you need to troubleshoot but still preserve the IV. Sometimes I see transparent dressing applied in such a way that there's very little tape on any part of the apparatus (Photo 4) and the IV is completely vulnerable.

Taping an IV is one of those things that people do a certain way because they've always done it that way. I'd like to see more research to assess the stability and practicality of peripheral IV taping methods, but using the "Cady IV Method" is a good start. This method makes it easier to see what's going on with the IV, keep better sterility and minimize the chances of the IV being pulled out. Don't cross the tape over the junction of the hub and IV tubing. Instead, place the Tegaderm over the IV catheter hub/tubing first.

DON'T DO THIS:

traditional taping 3. The traditional taping method is tough to troubleshoot.
little tape 4. With so little tape, the IV is much more vulnerable.
 
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