IV access ports

[courtenia]

I am a nursing student in a large metropolitan area and have had the unique experience of having clinicals in several different urban hospitals. And so, I see many different styles of practice from the nurses.

My biggest concern about the discrepancies I see is related to the access ports on IV tubing. When you are using them to either connect tubing or even just to flush the hep-lock line with NS, aren't you supposed to clean the port with alcohol first? Most professional nurses I observe do not do this.

If you do not clean the port, isn't there the potential of introducing bacteria directly into the patient's bloodstream? Also, when disconnecting a patient from their drip momentarily (for instance, if they are ambulatory and would like to take a shower) aren't you supposed to protect the insertion-end of the IV line by either capping it or reserving it in a (previously cleaned) access port? I see many nurses who just drape the line on the pole, with the insertion end touching all sorts of surfaces in the process. Doesn't this practice put the patient at risk for infection when the line is reconnected to their hep-lock?

If my concern about infection is valid, why do I see so many nurses practicing unsafely?

Thank you for the clarification.

[suanna]

Yes - you are supposed to swab the ports. In reality I have been told this is largely a practive more for the nurses than for any theraputic benefit to the patient. A quick swab with an alcohol pad is going to do very little to kill germs on the port- it is mostly just to remove any gross contamination. Still, it can't hurt- and it makes patients and falilies NUTS if you don't swab. Just for thier benefit I always swab.

[Daytonite, BSN, RN]

when you are using them to either connect tubing or even just to flush the hep-lock line with ns, aren't you supposed to clean the port with alcohol first? most professional nurses i observe do not do this.

yes.

also, when disconnecting a patient from their drip momentarily (for instance, if they are ambulatory and would like to take a shower) aren't you supposed to protect the insertion-end of the iv line by either capping it or reserving it in a (previously cleaned) access port? if my concern about infection is valid, why do i see so many nurses practicing unsafely?

yes.

what is right is often forgotten by what is convenient.

a long time ago i made a decision not to become lazy and to always endeavor to practice what i had learned in school. it is a choice each of us must make. obviously, some nurses made other choices.

[al7139, ASN, RN]

Hi,

You are right on both counts.

First, you should always swab with alcohol any port prior to connecting a syringe, tube, etc. to prevent infection. I disagree with the poster that says it's just to make the patient/family feel better. Think about it: the port has been exposed to the bed, the patient, had contact with who knows what, and if you don't swab, you risk introducing all kinds of bacteria to the patient. No, it is not an absolute guarantee the patient won't get an infection, but it is a good way to reduce the chances.

Second: I HATE when I see nurses do what you described and disconnect a line, and just hang it without capping it. When I find lines like that (for antibiotics, fluids etc. I change the line and the bag for the simple fact that it is now dirty and as in my first point it prevents infection.

The reality is that hospitals are disgustingly dirty. In this day and age with all the resistant strains of bacteria out there do you really want to take the lazy way out? Or do you want to see your patient back in a week with MRSA? I also glove up to do anything with an IV which many nurses may think is overkill, but I'm not taking any chances on 1. Being blamed for a hospital acquired infection or 2. Getting an infection from a patient or 3. Transferring an infection from one patient to another.

Recently, there was a pt on our unit who had been on another floor, but was transferred due to a heart condition (we are cardiac care) who got MRSA in the hospital. Turns out a nurse on the other unit had started an IV WITHOUT gloves. All I can say is this is an extreme example of stupidity for two reasons: you can give a patient an infection, and you risk contracting whatever the patient has.

Do what you KNOW is the right thing! Protect your patients and yourself.

Amy