CVC Cleansing Techniques?

[JStollRN]

I am a new RN on a Med-Surg Oncology floor and my preceptor was recently showing me how to cleanse the patient's infusaport for a dressing change. Now she was teaching me to cleanse with the chlorhexidine in a circular motion surrounding the device; however, I just completed a Continuing Education course on CVCs and it says to rub vigorously up and down to cleanse because there has been no evidence that the circular motion is more beneficial. Even in orientation, a different nurse told me to never clean anything in a circular motion anymore because you just end up bringing more bacteria back into the circle whether you mean to or not.

1. Any clarification on this? I just want to make sure I do what's right for my patients in the future.

2. Another side note, my preceptor also tells me not to use any type of alcohol or cleansing agent on the skin before an insulin injection. Is that okay too? It feels wrong to just inject someone without cleaning the site first.

Thanks so much for your help!

[IVRUS, BSN, RN]

If you read the IFU (instructions for use) on ChloraPrep, it will tell you to use the back and forth motion for skin antisepsis/cleansing, however, as an infusion nurse, I can tell you that using outward concentric is something we've been doing for years. However, there aren't studies which we can point to that say why we do it that way, or how the whole technique started. I too will tell students to start at the center with the Chloraprep swab head and after 30 second scrub, work out in outward concentric circles, never returning to the center. By doing it this way, since you have an indwelling IV catheter and a puncture site, one avoids dragging skin cells and other debris toward the insertion site. However, the IFU for this product, and FDA approval was with the back and forth motion. I am concerned that doing it in this fashion (BACK AND FORTH, while the catheter is indwelling) may dislodge the IV catheter, accidentally of course, but just as tragic.

So, as I said, I teach outward circles. But.. When there is not a line in place yet, and I'm using ChloraPrep, I use the back and forth motion for skin antispesis.

As far as cleaning the skin prior to injection, It's understood that one cannot "sterilize" the skin, but cleaning it prior to injection and allowing that cleanser (usually alcohol) to dry before injecting is the usual standard of care for most intitutions. Check with your organization for its standard or P&P. Many places in the UK aren't using alcohol to disinfect the skin prior to cleansing, but it is "usually" the policy here in the states.

[JStollRN]

If you read the IFU (instructions for use) on ChloraPrep, it will tell you to use the back and forth motion for skin antisepsis/cleansing, however, as an infusion nurse, I can tell you that using outward concentric is something we've been doing for years. However, there aren't studies which we can point to that say why we do it that way, or how the whole technique started. I too will tell students to start at the center with the Chloraprep swab head and after 30 second scrub, work out in outward concentric circles, never returning to the center. By doing it this way, since you have an indwelling IV catheter and a puncture site, one avoids dragging skin cells and other debris toward the insertion site. However, the IFU for this product, and FDA approval was with the back and forth motion. I am concerned that doing it in this fashion (BACK AND FORTH, while the catheter is indwelling) may dislodge the IV catheter, accidentally of course, but just as tragic.

So, as I said, I teach outward circles. But.. When there is not a line in place yet, and I'm using ChloraPrep, I use the back and forth motion for skin antispesis.

As far as cleaning the skin prior to injection, It's understood that one cannot "sterilize" the skin, but cleaning it prior to injection and allowing that cleanser (usually alcohol) to dry before injecting is the usual standard of care for most intitutions. Check with your organization for its standard or P&P. Many places in the UK aren't using alcohol to disinfect the skin prior to cleansing, but it is "usually" the policy here in the states.

Thanks for the response IVRUS! I went to a class today and asked about this and was told that technically, I should be using the back and forth technique, but the circular cleansing is okay as well for the infusaport.

Thanks again!

[iluvivt, BSN, RN]

YES agree 100 percent with IVRUS