Handling a central venous line port

[ddexter]

I have a few doubts lurking in my mind regarding the handling a CV line port during IV administration for which I could not find satisfactory/consistent answers by searching. Hence I'm asking them here.

1. Is hand hygiene and a 'no touch technique' of the ports sufficient or is a sterile glove mandatory prior to every use of the port?
   
2. Is cleaning of the ports with an alcohol/chlorhexidine based antiseptic solution mandatory before every use of the port?
   
3. How can the cap (which has been removed from the port for an IV infusion) of the CV line port kept sterile till the IV infusion gets completed? Is it safe to use it again or a new cap is required after each infusion?
   
4. Is it the usual practice everywhere to have the individual lines (lumens) of the CV line (for example the three lines of a triple lumen catheter) 'dressed' with a sterile gauze pack? Not doing so makes the lumens gets separated in different directions and sometimes they get contaminated by reaching unsterile areas like the hairy chest.
   

[Corey Narry, MSN, RN, NP]

When you've seen the ends wrapped with gauze, are you sure its not a dialysis catheter? Those usually are dressed in some fashion like that, and they are not meant for access other than dialysis unless you have a special order, and even then its usually just for the pigtail catheter. Not all dialysis caths have the pigtail.

I agree, while I've never seen that done where I work, I think that is mainly a way to remind nursing staff that these catheters are for hemodialysis purpose only.

[Sun0408, ASN, RN]

The blue caps you are referring to OP are at the time of insertion, they should be replaced with something along the lines of this,depending on your hospitals policy

Those caps stay in place for all meds and IV fluids/meds until time to change. The picture is of a PICC but the clear blue caps is what I am referring to. We have them on all our PIV,PICC's, and TLC's

[Sun0408, ASN, RN]

Clean gloves are needed to access the ports, after cleaning the port with alcohol pads or what ever your hospital uses.. I have only seen HD caths wrapped as you describe in earlier posts. Sterile gloves are needed of course at the time it is inserted and at all dressing changes..

[ddexter]

Thanks for the wealth of information everyone!

[KelRN215, BSN, RN]

The blue caps you are referring to OP are at the time of insertion, they should be replaced with something along the lines of this,depending on your hospitals policy

Those caps stay in place for all meds and IV fluids/meds until time to change. The picture is of a PICC but the clear blue caps is what I am referring to. We have them on all our PIV,PICC's, and TLC's

These are what I've seen on every kind of central line (Ports, PICCs, CVLs) that I've ever used. Never heard of any kind of "cap" that needed to be removed to administer an infusion.

And count me as another one who thought the OP was referring to accessing a port-a-cath.

[Sun0408, ASN, RN]

These are what I've seen on every kind of central line (Ports, PICCs, CVLs) that I've ever used. Never heard of any kind of "cap" that needed to be removed to administer an infusion.

And count me as another one who thought the OP was referring to accessing a port-a-cath.

I think this is what the OP was talking about...

[Sun0408, ASN, RN]

Our MD's are great about changing the caps at the time of insertion or we will do it shortly after :)

[MunoRN, RN]

I think there's confusion because "accessing a port" has two different meanings. Sterile gloves should be used when accessing an implanted port with a huber needle, but when accessing a port refers to the needless/luer lock connection point on the line itself then it is clean technique, with the exception of dialysis cath's in some policies.

[blondy2061h, MSN, RN]

There are, in some hospitals, little green caps that twist onto the hub of a line. They are alcohol impregnated on the inside and they are available to be placed on the end of a line in order to offer extra protection. However, they are by no means necessary and shouldn't be substituted for a good scrubbing of the hub before giving a med.

If you're referring to the Curos caps, then yes, they are substituted for scrubbing the hub.

When we do our stem cell reinfusions on the BMTU we remove the injection cap and go "hub to hub" with the transplant infusion tubing. Otherwise, all meds are administered through the injection caps. We only remove the caps for transplants, and once a week when changing them (or daily with TPN).

[ddexter]

@ Sun0408, That's exactly what I meant. Sorry for the confusion!

[wooh, BSN, RN]

Clean gloves may be required by policy, but they do NOTHING to protect the patient. After all, what touched the gloves to get them out of the box? What touched the gloves prior to YOU getting them out of the box, and did the last person that got gloves even wash their hands? Those gloves are just as dirty (and possibly dirtier) than the practitioner's washed hands.

ddexter, you really should discuss your concerns with your provider if you're unhappy with the care you received and have questions about it.

[Irish RN]

I agree...I don't wear gloves when pushing meds through a PIV or PICC line but I DO wash my hands. Also, most PP are referring to the "cap" but it's actually called a clave. And the clave MUST be changed after each blood draw from a PICC line. Obviously this is determined by hospital policy but if you are not changing the clave between blood draws your PICC lumens will clot off and will require tPA or a new line. Claves are also changed with dressing changes. Claves do not need to be changed between med infusions or med pushes. I scrub the hub with alcohol similar to a PIV but use a push-pause motion with administration.