Feels bad for not swabbing a vascular access port

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Hi Nurse Beth,

I found you on the allnurses page and would like some guidance, I am a recent grad. A while ago while working, I was changing a patient with another nurse and she wanted me connect the clysis on the side I was on, the patient was aggressive so I didn't have an alcohol swab on me so I didn't wipe it at the time due to the tense situation, about 5 minutes later, I got a swab and wiped it before connecting the patient. I totally forgot up until months later and I'm recalling back to the time I worked with the patient , they seemed to be at the same baseline as before (comfort care), I just need some guidance on this. It's the first and only time I haven't wiped a port before accessing it and I cannot help but feel bad not knowing what could have happened.

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10 Answers

Specializes in Tele, ICU, Staff Development.

Dear Feels Bad,

From what I gather, you accessed a vascular access port without "scrubbing the hub" and feel badly about the possible harm it could have caused to your patient.

It's good you're taking it seriously because when we drift from best practice with vascular access ports it can cause infection. With central lines in particular, we have to be very conscientious to avoid central line infections.

Every time you access a port, scrub the port for no less than 5 seconds. Only use alcohol swabs once. Get a new alcohol swab for each scrub. 

Let it go as a lesson learned, probably no harm done, and move forward.

Best wishes,

Nurse Beth

Specializes in Hospice.

Small technical point: a clysis is not a vascular access. The word is short for hypodermoclysis and the access is to subcutaneous tissue, not a blood vessel. It’s an old-time method of giving fluids and some meds from before the invention of intravenous technology. It has been resurrected, especially in hospice, as a less traumatic method of infusion than IV: much easier to start with fewer risks and complications.

Specializes in Hospice.

It’s a device. A clysis can be delivered through any needle suitable for subcutaneous injection that can be attached to IV tubing. There are also commercially available clysis sets. Site is prepped as with an IV insertion, clysis needle inserted, secured and hooked up to tubing and bob’s your uncle. Fluid bags are changed the same way as an IV infusion. Have never seen a piggyback on a clysis, so no swabbing needed on a Y port. As always with anything that pierces the skin, infection is a risk but, if it occurs, will likely remain local.

Specializes in oncology.
On 5/9/2021 at 10:34 AM, Nurse Beth said:

I was changing a patient with another nurse and she wanted me connect the clysis on the side I was on,

Stand your ground. if it was so important why didn't the off going nurse connect it...I don't care who is on what side of the bed, .  This is the oldest trick in the book,,,,don't know how to do something......leave it to the next shift. 

 Are there start kits available for this.?

BTW I gave fluids to my cat in renal failure this way. It is an OLD, OLD way to give fluids before the advent of IVs but it does work.

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I had hypodermoclysis in both thighs as a small child when I was severely dehydrated.  Of course, at the time I didn't know what the name of this was but just knew that it was very painful as it caused quite a bit of painful edema.  

Specializes in NICU.
On 5/9/2021 at 9:56 PM, heron said:

bob’s your uncle

I always loved using that phrase around my cousins. Bob is my father's name, so Bob really is their uncle.

Specializes in Dialysis.

In my area, clysis delivery is used often for dehydration in LTC patients. I loved it because it's so much less traumatic than IV delivery. Ours were changed out after each bag, a 1 time use set up, with site rotation to avoid localized edema and/or trauma

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
On 5/12/2021 at 11:07 AM, londonflo said:

BTW I gave fluids to my cat in renal failure this way. It is an OLD, OLD way to give fluids before the advent of IVs but it does work.

I did too! She hated it but tolerated it. She had tongue cancer and had a partial tongue resection and couldn't drink, the resection was a final effort to see if we could save her. Unfortunately not, my sweet kitty. ? 

Specializes in Hospice.
NICU Guy said:

I always loved using that phrase around my cousins. Bob is my father's name, so Bob really is their uncle.

The saying goes back to the founder of London's police force at the turn of the 17th century. His name was Robert Peel, hence the "bobbies" = police officers. "Bob's (aka Peel or his bobbies) you uncle = you've got it made in the shade.

Specializes in Tele, ICU, Staff Development.
heron said:

Small technical point: a clysis is not a vascular access. The word is short for hypodermoclysis and the access is to subcutaneous tissue, not a blood vessel. It's an old-time method of giving fluids and some meds from before the invention of intravenous technology. It has been resurrected, especially in hospice, as a less traumatic method of infusion than IV: much easier to start with fewer risks and complications.

Thank you, I did not know! Never make assumptions, right? Heron, how important is it to swab the site, or is it a device?

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