Betadine? Alcohol? (one, the other, or both?)

[ceecel.dee]

Attended an IV inservice yesterday where a debate broke out about proper IV site prep.

The (very qualified) speaker/presenter thought that Betadine alone should suffice, and is how she practices.

One of our more experienced nurses piped up to say all she ever uses is alcohol alone and that she did not have any instances of site problems.

I've always used an alcohol prep to defat the area, followed by a betadine prep (allowed to do some drying) to prep my sites. I actually did a research paper on this years ago that convinced me this was the best technique to use, was taught this technique in school, and it is our hospital policy as site prep.

It's been a long time since I've seen any new research on this. What do you guys do?

[jemb]

We use just alcohol scrubs for peripheral IV sticks. For ports, and for all central line dressing changes, we have started using chlorohexadine, though. We had previously used alcohol first, then betadine for those sites, and still use that for PICC line insertions.

The following info is from www.apic.org (infection control association) . They say either/or.

Cutaneous antisepsis

1. Disinfect clean skin with an appropriate antiseptic before catheter insertion and during dressing changes. Although a 2% chlorhexidine-based preparation is preferred, tincture of iodine, an iodophor, or 70% alcohol can be used (73,75,207,208). Category IA

2. No recommendation can be made for the use of chlorhexidine in infants aged

3. Allow the antiseptic to remain on the insertion site and to air dry before catheter insertion. Allow povidone iodine to remain on the skin for at least 2 minutes, or longer if it is not yet dry before insertion (73,75,207,208). Category IB

4. Do not apply organic solvents (e.g., acetone and ether) to the skin before insertion of catheters or during dressing changes (209). Category IA

[Marie_LPN, RN, LPN, RN]

Originally posted by jnette

Interesting... our policy has us doing the exact opposite. Betadine first, let sit 5 minutes, then the alch. prep.

That's our facility policy.

[geekgolightly, BSN, RN]

Originally posted by jemb

We use just alcohol scrubs for peripheral IV sticks. For ports, and for all central line dressing changes, we have started using chlorohexadine, though. We had previously used alcohol first, then betadine for those sites, and still use that for PICC line insertions.

The following info is from www.apic.org (infection control association) . They say either/or.

Cutaneous antisepsis

1. Disinfect clean skin with an appropriate antiseptic before catheter insertion and during dressing changes. Although a 2% chlorhexidine-based preparation is preferred, tincture of iodine, an iodophor, or 70% alcohol can be used (73,75,207,208). Category IA

2. No recommendation can be made for the use of chlorhexidine in infants aged

3. Allow the antiseptic to remain on the insertion site and to air dry before catheter insertion. Allow povidone iodine to remain on the skin for at least 2 minutes, or longer if it is not yet dry before insertion (73,75,207,208). Category IB

4. Do not apply organic solvents (e.g., acetone and ether) to the skin before insertion of catheters or during dressing changes (209). Category IA

rock. thank you!

[jjjoy, LPN]

Do you actually wait two minutes or more for the betadyne to dry? I haven't much experience with IV starts but when I've witnessed others, they didn't seem to wait that long.

[gwenith, BSN, RN]

You are SUPPOSED to wait two minutes as it maximizes the bacteriocidal effects but in reality few seem to do so. Possibly the best way around this is to prep first and then organise your equipment so that it does not feel like you are wasting your two (precious scarce!) minutes.

[Brita01]

Interesting topic. My patient's mother and I had this conversation a couple of days ago during a central line dressing change. I was taught betadine first, then alcohol. Then another hospital I went to work for taught alcohol first, then betadine. The mother was taught betadine first, then alcohol. Then when we opened up a central line kit, this particular kit had instructions that said alcohol first, then betadine. Both ways must be acceptable. I just remember being taught that it's not good to let the betadine sit on the skin for long periods.

[caroladybelle, BSN, RN]

Betadine should be dried and stay on site to be most effective. To wipe with alcohol after, defeats much of the purpose of it. And, yes, betadine does irritate the skin (just as tape/tegaderm does) and slightly obscure the site (just as using gauze in place of clear tegaderm does). That is why many places are switching to chlorahexidine, which does not require drying time, or obscure the site, and is more effective and does not contain iodine (less allergies.

A lot of it deals with what is more necessary for the patient. Do we need to have continuous clear visualization of the site, despite some tape irritation, or could gauze be used. We have to weigh the individual patients needs/problems for best choice.

I personally prefer chlorahexidine prep, no gauze and a clear tagaderm, for most of my patients.

[Mimi2RN, ASN, RN]

Reading through these, it seems that no-one knows which is the best way to prep. If you have no or very low incedence of infection, is must be that all these methods work.

We use betadine then alcohol on adults, but you only have to wait 45 seconds. On babies we just use alcohol, with no history of infections in my unit

The only time betadine is used, it's for UAC/UVC or LP skin preps.

We do use veniguards for dressings, the foam tape is useful under the hub to protect the skin from the pressure of the catheter.

[Dplear]

Betadine is a cytotoxic agent. Alot of hospitals have gotten away fromusing it completely. Here at TCh we use alcohol only for periph. IV sticks.

Dave

[SmilingBluEyes]

Rarely use betadine here. Just a good cleaning w/alcohol wipe. Have not heard of any cases of phlebitis or site infections on IVs started in our unit. But then, we are dealing with healthy young people. Was told betadine creates more problems than it is worth for peripheral sites.

[ceecel.dee, MSN, RN]

Wow! What a variety of techniques! I guess it's like many things...there are more than one "right" way to do things!:)

[Momto3RN, RN]

I was taught alcohol first then betadyne which I do for PICC changes but for peripherals I use only alcohol.

And mostly for the fact that betadyne diminishes my view and I can't locate the veins as well so I usually end up wiping most of it off anyway. . I'm definitely not a pro at IVs! Well, not yet, anyway!