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Do you scrub the hub of a PICC between each medication?

Updated | Posted

Hi! I’m a new grad currently orienting to my unit and this question came up the other day. Basically, I was heparin locking a PICC at shift change. I disconnected the IV tubing, scrubbed the hub, attached a saline syringe and checked blood return then flushed. Then, I went to grab the heparin flush. I asked my preceptor if I needed to scrub the hub again before attaching the heparin flush, and she said no (which is also how I learned to do it during my critical care rotation in school). So I uncapped the heparin and went to attach the syringe, and the oncoming nurse I had given report to kind of hit me on the shoulder and said “alcohol swab please.” I’m not confused on which is the proper practice, and we didn’t have time to see if our hospital policy addresses this.

So, if you’re giving multiple meds or flushes through a PICC at the same time, do you scrub the hub before attaching each syringe, or do you just do it once?

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

At my facility you are supposed to scrub the hub any time you are connecting something new into it, so yes you would have scrubbed it in between the saline flush and the heparin flush.

Because of this, we often use stopcocks to decrease line entry and not have to do an additional line scrub. The stopcock would have both saline and heparin flush on it, thus only needing to enter and scrub the line once for both flushes.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

What does the policy say?

As an aside, when I did scrub hubs I did so between med doses because I was absolutely, positively freaked out about infection (because I was trained to see sepsis and sources of sepsis everywhere).

WestCoastSunRN, MSN, CNS

Specializes in CVICU, MICU, Burn ICU. Has 25 years experience.

Yes scrub the hub. It's the right way to do things and there is a reason for it (takes less than 5 seconds for bacteria in air to get onto hub). That's why the oncoming nurse said something. You should also know your policy, but if your policy doesn't call for this practice, it should.

Lots of scrubbing.

Drying time is the thing that seems to be lost on many people.

Yes, you should have scrubbed. I don’t understand the rationale for not scrubbing. You put the hub down, left the room. The hub would have come into contact with possible bacteria in that time frame.

I didn’t know facilitates still heparin locked piccs.

21 minutes ago, LovingLife123 said:

You put the hub down, left the room. The hub would have come into contact with possible bacteria in that time frame.

Fairly certain that's not what s/he meant since s/he did not say anything about putting anything down or leaving the room.

"Went to grab" = reached for or was in the process of picking up

(If it sounds quite absurd, there might be another interpretation that is more likely.)

15 hours ago, JKL33 said:

Fairly certain that's not what s/he meant since s/he did not say anything about putting anything down or leaving the room.

"Went to grab" = reached for or was in the process of picking up

(If it sounds quite absurd, there might be another interpretation that is more likely.)

Went to grab means to me, walking away from it even if it’s just across the room or bed. That hub should not leave you once it’s scrubbed and dry.

I would like the rationale for not scrubbing it.

Edited by LovingLife123

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

16 hours ago, LovingLife123 said:

Yes, you should have scrubbed. I don’t understand the rationale for not scrubbing. You put the hub down, left the room. The hub would have come into contact with possible bacteria in that time frame.

I didn’t know facilitates still heparin locked piccs.

I didn’t interpret it as the OP put the hub down, I assumed they meant reached for it. But that could be just an assumption on my part because it wouldn’t make sense to put the hub down.

I’m curious, why are you surprised about heparin locking a PICC? What is the alternative, KVO?

Edited by JadedCPN
Typo

If it is a valved PICC Heparin is not required. The only care is weekly flushing with saline, cap and dressing changes.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

11 minutes ago, Wuzzie said:

If it is a valved PICC Heparin is not required. The only care is weekly flushing with saline, cap and dressing changes.

Thanks for the information. I've only ever dealt with smaller PICCs in pediatrics where you have to heparin lock it between each use because they clot off so easily.

25 minutes ago, JadedCPN said:

I didn’t interpret it as the OP put the hub down, I assumed they meant reached for it. But that could be just an assumption on my part because it wouldn’t make sense to put the hub down.

I’m curious, why are you surprised about heparin locking a PICC? What is the alternative, KVO?

We have orders to saline flush q8 for a PICC. We use cathflo if a lumen stops working. With cathflo, you end up aspirating the Alteplase so none goes to the patient.

I know there are numerous studies on whether any of the medication reaches the pt, but at this time our policy is for it not to.

The problem with our policy is nurses don’t flush q8 so they end up not working frequently. It absolutely drives me nuts. That, and not properly flushing small bowel feeding tubes. I get crappy about it. It’s a waste of my time and charge to the pt when things clog up.

24 minutes ago, LovingLife123 said:

The problem with our policy is nurses don’t flush q8 so they end up not working frequently.

Are they valved or not valved PICCs?

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Our policy is to only scrub prior to the first access of the hub so long as control of the hub is continuously maintained, this is because we've found there is far better adherence to proper technique when only one cleaning of the hub is required, and really it's mainly the first cleaning that matters.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

4 hours ago, LovingLife123 said:

We have orders to saline flush q8 for a PICC. We use cathflo if a lumen stops working. With cathflo, you end up aspirating the Alteplase so none goes to the patient.

I know there are numerous studies on whether any of the medication reaches the pt, but at this time our policy is for it not to.

The problem with our policy is nurses don’t flush q8 so they end up not working frequently. It absolutely drives me nuts. That, and not properly flushing small bowel feeding tubes. I get crappy about it. It’s a waste of my time and charge to the pt when things clog up.

The most common reason for using alteplase for lumen maintenance is for lack of blood return, which is most commonly due to an extraluminal clot or "tail", and the only way for the alteplase to get to that is to allow it to flow past the tip of the lumen. The dose used and the half-life of alteplase results in effectively no systemic effects from pushing a small amount out the end of the lumen.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Scrub the hub every time. It takes only 15 seconds and could help prevent an infection.

medic981, ADN, RN, EMT-P

Specializes in Emergency Nursing. Has 5 years experience.

As long as I know that I have maintained control of the hub after scrubbing it, then no, I do not scrub it after each medication. If there is a doubt in my mind that the hub touched something then I go ahead and scrub the hub for again for 15 seconds.