Anesthesia and Cleaning Ports?!

[technically...]

I have been a nurse in the OR for only a few months, and was an LPN at a clinic prior to beginning this job, however I am shocked at Anesthesia's practices in regards to cleaning of IV injection ports. As a nurse I was taught and practiced cleaning of IV injection ports prior to injection each and every time. I have witnessed EVERY anesthesiologist inject medication without ANY cleansing done...this include atrial lines, IV lines, and every other line I have every witnessed performed. I brought this practice up with my supervisor, who told me this was common practice and that when she had confronted an anesthsiologist he demanded she show proof that cleansing of the port was necessary. I have been all over the web in search of articles or evidenced based studies in regards to cleaning an injection port prior to administration of a medication, peripherial lines (not just central).

Is there anyone who has links or supporting documentation I can bring to my adminsitration about this "substandard" practice of not cleaning IV ports? I am desperately trying to change this ongoing practice in my hospital.

Thanks-

[Esme12, ASN, BSN, RN]

I hope the anesthesia dept isn't injecting anything into the art lines. Surgical draping does at times prevent the conventional swabing of ports.

While is is proven that cleaning the IV port prior to use does decrease catheter induced infections....but before taking on the big guys I advise you with caution. Hospitals do NOT like those who point out mistakes nor are the REALLY interested in the correction of the behavior if it involves physicians.

The right path is not always the easy one......here are some resources.

http://cid.oxfordjournals.org/content/32/9/1249.full

CDC - CMS Hospital Inpatient Quality Reporting Program - NHSN

[Rose_Queen, BSN, MSN, RN]

First of all, I highly doubt that any of your patients have atrial lines. They may, however, have arterial lines. No medications should be injected into these lines; they are solely for invasive blood pressure monitoring and possibly for drawing blood for labs. Also, where in the IV line are they injecting medications? Most of the docs I work with do not use the traditional port that you would hook a secondary line into; they use an extender that has several ports covered with sterile caps. The caps are removed to inject medications, sterility of the cap is maintained or a new cap is obtained, and the cap is replaced immediately following the injection. Alcohol swabs should not be used with these because there would be no barrier between the alcohol swab and the running fluid; also, as long as the syringe hub and port cap sterility is maintained, you are not breaking the sterility of the system.

[wtbcrna, MSN, DNP, CRNA]

I hope the anesthesia dept isn't injecting anything into the art lines. Surgical draping does at times prevent the conventional swabing of ports.

While is is proven that cleaning the IV port prior to use does decrease catheter induced infections....but before taking on the big guys I advise you with caution. Hospitals do NOT like those who point out mistakes nor are the REALLY interested in the correction of the behavior if it involves physicians.

The right path is not always the easy one......here are some resources.

Guidelines for the Management of Intravascular Catheter-Related Infections

CDC - CMS Hospital Inpatient Quality Reporting Program - NHSN

I am one of those anesthesia providers that do not routinely clean injection ports unless the IV is coming from the inpatient floor or ER, and those are often visibly dirty. Otherwise, most of my surgical cases the IV is in less than 12hrs and we routinely use the manifold system as stated above which is a sterile closed system. I have not seen any literature to suggest that wiping off the injection ports with alcohol helps to reduce infection rates in peripheral IVs. I looked through both of the links above and was unable to find any related information about cleaning the injection ports on peripheral IVs helps reduce infection rates.