chloaprep & open fractures??

[Kingbandit]

Recently our OR started pushing our Dr's to use Chloraprep. Last week one of our ortho Dr's demanded the nurse prep an open femur fracture. His reasoning was that he had reformed a pre-scrub with a chlohexidine scrub brush. The nurse refused and he proceeded to prep himself. Afterward, th Dr wrote up the rn she has not heard back from management yet but she's afraid she'll get in trouble. Everyone that has heard the story backs her because the manufacurers instructions state not to use on mucous membranes, eyes, ears, or open wounds. What are your thoughts?

[MamaCheese]

I would have done exactly what she did. We do an old fashioned betadine scrub and paint on open wounds. Why is it that such educated people can be such doofuses?

[Argo]

I would do just as she Did and also would have weiten an incident report since its against manufacturers recommendations. Especially since the Dr had issues with Her.

[GadgetRN71, ASN, RN]

We do many, many open fractures and do not use Choloraprep on open wounds. So, the RN did the right thing..also, what's this about a doc writing a nurse up? Last I checked, they don't sign our paychecks..OP, I wouldn't be worried if I were the RN in question-she advocated for that patient and I believe her boss(nursing supervisor, NOT a doctor, LOL) will back her.

[MereSanity]

I would have done the same thing. It's her license on the line. Dr's don't know everything.

[NurseLumpia]

should report to patient safety hotline

[Mr. & Mrs. RN]

Yes, she did the correct thing. It contains alcohol which cannot go on mucous membranes or open wounds. Using anything off label is inappropriate and the hospital will not back that doctor up.

[PetiteOpRN]

It is my understanding that chlorahexidine (chloraprep, duraprep, hibiclens, exidine) is toxic to CSF and contraindicated for use on mucous membranes. In the OR where I work (large teaching hospital) we regularly use chlorahexidine-based preps on open wounds. We have had nurses question whether or not this is ok, and the doctors all tend to say something along the lines of, "show me a mucous membrane in that wound and we can discuss other prepping options."

In my experience, when there is a situation like the OP mentioned, management comes up with a protocol regarding the solution. At our hospital, the protocol is that chlorahexidine is ok except on the face, groin, and spinal cases.