alcohol site prep

One of the reasons why we have a standing protocol to replace field-placed IV's as soon as the patient gets in the unit.

Every hospital I have worked at has that protocol. BUT I'm trying to make a change in my class so they know to clean the sites properly. not that it will change the protocol but at least 30 medics from my class will do it right.

The INS standard is a 30 second friction scrub. You should also never touch the insertion site or cannula once its been prepped. You shouldnt place tape under the opsite as well.

The instructor has piss poor technique and should be called on it. Although most medics would cringe on stating the "INS states this" because most medics would laugh at what a nursing text states........So refer him to the CDC MMR on prevention of catheter related infections, or the current BRADY Paramedic manual which states basically the same thing.

This is in the same lines as the nurse who doenst wear gloves, or the nurse who breaks the glove off of one finger.......

Poor technique leading to patient danger............

Yes, You are correct about the friction scrub, and using the no-touch technique after prepping, but INS does not discourage tape (sterile tape) under the dressings. As a matter of fact, it is encouraged to prevent catheter movement in the vein and subsequent mechanical phlebitis.

Now, we are not talking talk that has been rolling around in your pocket, but tape that just came out of a sterile IV statrt kit. :kiss

The INS standard is a 30 second friction scrub. You should also never touch the insertion site or cannula once its been prepped. You shouldnt place tape under the opsite as well.

The instructor has piss poor technique and should be called on it. Although most medics would cringe on stating the "INS states this" because most medics would laugh at what a nursing text states........So refer him to the CDC MMR on prevention of catheter related infections, or the current BRADY Paramedic manual which states basically the same thing.

This is in the same lines as the nurse who doenst wear gloves, or the nurse who breaks the glove off of one finger.......

Poor technique leading to patient danger............

I plan on talking to my lead instructor about this but I am wondering according the the INS how long should you clean the site with alcohol before inserting and should you let it dry?

I don't know the number of seconds but I'd think at least 10 seconds with good friction and letting it dry.

I think it is good to talk to the instructor about it.

One swipe of alchol really isn't going to do anything. It isn't really the alcohol that is cleaning as much as it is the scrubbing of the skin.

You need to scrub starting at the insertion site and in a circular motion going outward. You are then to let the alcohol dry for a minimum of 30 seconds but I think the INS standard is a minute.

They must definately not be touching the catheters...only the section they are suppose to hold.

When I learned in paramedic class (20 years ago), we were taught to clean with betadine in circular pattern out from site, wait 30 sec. then wipe with alcohol from center out to remove the betadine. However, I've seen some real strange stuff from some of the new people coming out of class. So I'm glad the IVs are replaced.

In my opinion QC oversite is quite poor for paramedics. It would probably good to have mandatory refresher classes on aseptic technique for the medics taught by experts in the field, but there would probably be a lot of problems trying to mandate that, unless it was mandated on a regional or statewide basis.

please tell me this is a joke.

OK, the ONLY thing alcohol does is remove oils from the skin, it is a poor antiseptic, we use alcohol then betadine to prep our sites, and it is mostly the friction that does the work. Also, if you put the tegaderm or sorbaview or whatever your occlusive dressing is over the insertion site first, then chevron the tape from under the catheter hub and then bring the tape up parallel on each side of the catheter (not across it as this can cause irritation to the site from the pressure) on top of the occlusive dressing, and PLEASE put on an extension, DON'T insert the tubing/needleless adaptor directly to the hub of the intracath since this causes movement of the catheter which will lead to pain, leaking at the site, dislodging of the catheter. Nothing makes me madder then to see IV sites with poor dressing and securing technique and the patient has be be restuck because the weight of the tubing has pulled out the catheter. This extra time at the beginning will save time later and spare the patient another stick. jb

Anyone use ChlorPrep (the small tubes) to prep for their IV sites?

We use the big ChlorPrep for our PICCs, would love to have the small ones for our IV starts but our manager said they are too expensive, 43 cents each...jb

There are many times I'm proud to be an EMT-I, and then there are times when I wish all I can do is appologize over and over for us.

Kelly911, if you haven't done so already, that instructor needs to be corrected in some sort of respectful manner. If he doesn't heed the advice of the "standard of care" (whichever reference is used to show him), you need to go higher up. I didn't realize I was doing piss-poor IV techniques *until* an RN kindly showed me in the ER; she showed no anger, but was extremely helpful knowing that some folks are just worthless teachers.

Keep in mind, most instructors are also "still in the field" to maintain their certification/license and skills. If they are working for an EMS or any ambulance service, they have a Medical Director (physician) to answer to. I've gone that route when the hardheaded instructor decided to plant his heels, and the Medical Director handled the situation well. It's his/her medical license on the line, so there's a lot at stake.

Without some sort of action/education to change what is wrong, the fresh-outta-school medics may never learn unless specifically pulled aside by another medical professional, whether it be another medic, nurse, or physician. I was very fortunate, for this RN understood what was going on in my education, and had the courage and patience to help, instead of taking the easy route of just bad-mouthing medics. Thanks is not enough for what she did for me, and my future patients.

Good luck!