Chloraprep reuse for IV insertion

[TXAZRNED2017]

I am a nursing instructor and have observed nurses in the Pre-op area at one of our local hospitals reuse the chloraprep applicator from one IV site attempt to a second site. Is this best practice? I would not reuse an alcohol prep pad from one site to another, and just need someone to provide me information. I read a post from 2012 that stated the Chloraprep antimicrobial action lasts 5-6 hours and if the swab is still wet it is acceptable. I need written evidence to provide to my students that this is or isn't acceptable best practice for preventing IV site infections.

Can anyone help with this?

Thank you in advance.

[IVRUS, BSN, RN]

I would go to the BD website. On their videos regarding the ChloraPrep Frepp applicator, it reviews proper cleansing techniques and states, "DISCARD AFTER A SINGLE USE!!!"

That's the manufacturers IFU... which should be enough PROOF.

[offlabel]

I would go to the BD website. On their videos regarding the ChloraPrep Frepp applicator, it reviews proper cleansing techniques and states, "DISCARD AFTER A SINGLE USE!!!"

That's the manufacturers IFU... which should be enough PROOF.

Single use could mean a single patient. Someone with a filthy arm after crashing his bike is no less "clean" after a chloraprep than an elderly patient in the hospital getting a second iv stick with a twice used swab. And it is in the manufacturers interest that more rather than less swabs are used. Using them between patients is obviously not smart, but if there is solution left in the device, why not with the same patient? I do that all the time.

"Best Practice" cannot and should not be reduced to "it just doesn't seem right".

[MunoRN, RN]

Whether it's acceptable practice would be based on the rationale being presented for saying it's not. If the argument is that once it touches skin it should be considered 'dirty' and no longer be used then it can never be used it all, since once it touches skin it must be disposed of, obviously that doesn't make any sense.

The extent a chloraprep applicator can be used is based on surface area, the smallest are only intended for a 2.5" x 2.5" area, but in my experience PACU typically uses OR stock, which means much larger volume applicators which would be more than sufficient for two different IV sites. This would still be considered "single use".

[NICU Guy, BSN, RN]

What would the rationale be for not using the applicator on a second site if you still chloraprep in the applicator?

[IVRUS, BSN, RN]

Single use could mean a single patient. Someone with a filthy arm after crashing his bike is no less "clean" after a chloraprep than an elderly patient in the hospital getting a second iv stick with a twice used swab. And it is in the manufacturers interest that more rather than less swabs are used. Using them between patients is obviously not smart, but if there is solution left in the device, why not with the same patient? I do that all the time.

"Best Practice" cannot and should not be reduced to "it just doesn't seem right".

Single use does NOT mean single patient... It means, once it's used, discard.

[MunoRN, RN]

Single use does NOT mean single patient... It means, once it's used, discard.

Using it for an IV insertion, putting it back into the package and sticking it in a drawer in case the patient needs an IV later would be multi-use, using it on another patient would be multi-use, using it for two different sites in a continuous IV-start procedure would be single use. What rationale are you using to argue that it shouldn't be used for two different sites at once so long as it can cover that quantity of surface area?

[IVRUS, BSN, RN]

It is important to know the meaning of single use... ie. IV catheters are single use too. Once attempts are made to place it, and if it fails, one cannot use that same SINGLE USE item and restick it into another vein!

Since Chloraprep IFU states: "discard the applicator after a single use along with any portion of the solution not required to cover the prep area. It is not necessary to use the entire amount available."

And they state NOT to touch the sponge in any way, if one cleanses the area, then lays the applicator/sponge down, they can't pick that sponge up and reuse it!

However, if one cleanses the entire area over the vessels and then chooses to try another vein (like going from the median antecubital to the accessory cephalic, because successful entry wasn't obtained with first stick) then that is acceptable, but it's not acceptable to pick up the discarded cleanser and reuse it.

[Corey Narry, MSN, RN, NP]

According to this guideline single use means single patient: Labeling Recommendations for Single-Use Devices Reprocessed by Third Parties and Hospitals; Final Guidance for Industry and FDA

Single-use device:A single-use device, also referred to as a disposable device, intended for use on one patient during a single procedure. It is not intended to be reprocessed (cleaned, disinfected/sterilized) and used on another patient. The labeling may or may not identify the device as single use or disposable and does not include instructions for reprocessing.

You never re-use an IV catheter once you failed an insertion for many reasons: you risk a needle stick injury if you replace the sharp needle back into the catheter, you could damage the catheter as the needle goes through the lumen of it, the needle could be occluded with a blood clot making it difficult to see a flash, and you've lost the initial sharpness of the bevel once you've used it.

[offlabel]

According to this guideline single use means single patient: Labeling Recommendations for Single-Use Devices Reprocessed by Third Parties and Hospitals; Final Guidance for Industry and FDA

Single-use device:A single-use device, also referred to as a disposable device, intended for use on one patient during a single procedure. It is not intended to be reprocessed (cleaned, disinfected/sterilized) and used on another patient. The labeling may or may not identify the device as single use or disposable and does not include instructions for reprocessing.

You never re-use an IV catheter once you failed an insertion for many reasons: you risk a needle stick injury if you replace the sharp needle back into the catheter, you could damage the catheter as the needle goes through the lumen of it, the needle could be occluded with a blood clot making it difficult to see a flash, and you've lost the initial sharpness of the bevel once you've used it.

There are many single use procedural trays that are just not used that way at all in day to day practice. Contents (needles) in central line trays, epidurals, arterial line trays etc are not thrown away after unsuccessful attempts. They're used until the line or catheter is in. Manufacturer recommendations for single use have far less to do with the practicalities and limits of the devices than they do with liability for the company.

Disposable scalpels are labeled as single use and to throw them away after each time they're applied to the same patient would be silly.