Handling a central venous line port

Nurses General Nursing

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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.

Specializes in NICU, PICU, PACU.

Go by your hospital policy. Central line infection is a big buzz! We have to wear gloves whenever we access a line. Before we started wearing gloves we did blind audits and found people washed/sanitized and then touched a bunch of stuff then accessed the line. I get where you are coming from about the box, and I agree, but when we instituted gloves and then did the blind audits we found people got right to business with meds and flushes.

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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.

All depends on the brand. Thus hospital policy is important. And where OP should direct his/her questions.

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Specializes in Pedi.
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.

This isn't across the board true. Policy at my place of work is to change caps q 96 hrs and, for PICC lines, they're changed once/week if the patient is home with it. I've drawn blood off of PICCs a million times without changing the cap afterwards and have not had problems with them clotting.

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Not wearing gloves to put meds in a picc line?

Wow!

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Specializes in CICU.
Not wearing gloves to put meds in a picc line?

Wow!

What do the gloves help?

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What do the gloves help?

I wear gloves to protect myself, if not the patient. Our radiology dept left some of the central lines pretty bloody after insertion. I don't want my patients' blood on my hands even if I am going to wash my hands afterward. I always clean the line itself when I see blood on it but those things get nasty and not everyone cleans them.

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Specializes in Critical Care.
What do the gloves help?

From the CDC's "Guideline for hand-washing in healthcare settings", the purpose of non-sterile exam gloves is:

Reduce the risk of personnel acquiring infections from patients

Prevent healthcare flora from being transmitted to patients

Reduce transient contamination of the hands of personnel by flora that can be transmitted from one patient to another.

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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

I don't think I have seen a policy requiring gloves to handle IV access, but if you were required to wear gloves, I can't see sterile gloves being required. Even wearing gloves, you wouldn't want to touch the hub of the access port.

Is cleaning of the ports with an alcohol/chlorhexidine based antiseptic solution mandatory before every use of the port?

Alcohol yes, chlorohexidine, check your hospital policy because the hospital may include that for central lines. our critical care units require you to "scrub the hub" for 30 seconds. the literature (i've been told) says you need at least 15 seconds of hub cleaning in order to kill the bacteria. Some areas of our hospital and some other hospitals in the area use an alcohol or cholorohexidine impregnated attachment that cleans the port/hub for the RN. All you do is put it on and the next time you want to use the port, you remove it and use it right away.

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?

If you are talking about the same cap I am thinking about, why are you removing it at all? You shouldn't need to remove the cap for an infusion (hence why they are also referred to in technical terms as an intermittent infusion device). Sure, you need to change it after certain things (like blood draws and blood administration), but you shouldn't need to remove it for a standard IV infusion. Once removed, get a new one.

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.

Its okay for the lumens to be on the patient's body, that's why you "scrub the hub" in the first place, to kill the bacteria that may be on the lumen. The chest hair will likely contain the same normal flora as the rest of the body. Also, once you walk away from the patient, that sterile technique you used is no longer considered sterile. I have seen things like this (putting an alcohol pad package over an IV cap), but this is not an approved cleaning technique at our hospital.

Hope this helped a little.

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Specializes in Public Health, TB.

Hello All--

I am just starting at my new job as clinical instructor for RN students and this week we've been covering IV skills. The final quarter students have been doing skills check-offs for those just starting their second year. They insist that priming the IV caps and or /claves for both peripheral and PICC lines is necessary prior to attaching them. I Have looked at this site and at the manufacturers' sites and cannot find any reference to "priming" caps. Can anyone point me to a reference supporting priming caps/claves?

Thanks in advance.

J

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Hello All--

I am just starting at my new job as clinical instructor for RN students and this week we've been covering IV skills. The final quarter students have been doing skills check-offs for those just starting their second year. They insist that priming the IV caps and or /claves for both peripheral and PICC lines is necessary prior to attaching them. I Have looked at this site and at the manufacturers' sites and cannot find any reference to "priming" caps. Can anyone point me to a reference supporting priming caps/claves?

Thanks in advance.

J

Priming as in instilling saline into the needleless access device prior to attaching? Any reason why you would not prime the needleless access device?

Ask you local rep, they will truly be the best source of information on this. Have you checked your IFUs?

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Specializes in Public Health, TB.

It's seems like an extra, unnessary step for nursing students struggling to learn a new skill. My understanding is there is negligible volume within the cap.

I am at the local technical college so no rep to contact. I shall e-mail the manufacturer.

IFU?

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It's seems like an extra, unnessary step for nursing students struggling to learn a new skill. My understanding is there is negligible volume within the cap.

I am at the local technical college so no rep to contact. I shall e-mail the manufacturer.

IFU?

Good practice is never an extra nor unnecessary. Reasonable and prudent care is never about eliminating as many seemingly "unnecessary" steps as possible but rather eliminating as many risks to the patient as possible, even if they are minor.

Everyone in the world has a rep assigned to them. Contacting the manufacturer is the prudent thing to do, it will get you into contact with tech services. You can also ask who your local rep is so that you can ask further questions or even have them come and in-service your nurses.

The IFU is the Instructions For Use, the document that is placed inside every box of medical devices that everyone throws away.

Much as you should be reading the medication administration insert in a box of meds, you should be reading the IFU on medical devices. This goes doubly if you are educating on the use of a product. How do you know what you are teaching is anywhere near what should be done if you do not know what the actual instructions are?

The IFU is EXTREMELY important to know what the limitations, purpose, and special considerations should be taken with any medical device. As an educator you really should be very familiar with every IFU for every product that you are teaching on.

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