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

[Wuzzie]

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]

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]

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]

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

[Wish4goodstaffing]

Yes!

[medic981, ADN, RN, EMT-P]

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.

[NewOncNurseRN, BSN, RN]

Scrub the hub every time it is accessed! We use chlorhexidine wipes so it’s only 5 seconds and therefore no excuse to not do. It should also be capped in between uses since it is a central line. We flush with each shift change, before and after meds, before and after lines are connected/disconnected, and before and after labs. PICCs can be really finicky and we still sometimes have to Cathflo.

[balletomane, ADN, RN]

I work in oncology/neurology where we have many PICCs. We don't heparinize them. Only a central lines.

[JKL33]

removed.

[Nurse Beth, MSN]

The Infusion Nurses Society Infusion Therapy Standards of Practice 2016 says

that "multiple accesses of the VAD may be required to administer a medication... and require additional disinfection before each entry"

[MunoRN, RN]

1 hour ago, Nurse Beth said:

The Infusion Nurses Society Infusion Therapy Standards of Practice 2016 says

that "multiple accesses of the VAD may be required to administer a medication... and require additional disinfection before each entry"

It should be pointed out that the INS is of questionable reliability when it comes to practice recommendations, and this particular recommendation is not backed by any evidence or even rationale.

If the only effect of this recommendation was that it wastes time then maybe it could be allowed to slide, but what it does is to dilute the focus and therefore effort of hub asepsis which should be completely focused on the initial scrub and anytime after asepsis may not have been maintained, it serves no purpose where asepsis has been maintained.

[CapeCodMermaid, RN]

Who said the INS is of questionable reliability? Many policies at many facilities are based on their recommendations