IV Site Prep

bobnurse · Dec 24, 2004

yeah, in regards to resuscitation, i was always told its easier to cure an infection than death, so just get the IV in..........Bring them back and worry about the infection.

curleysue · Dec 24, 2004

I have my port accessed twice a week for PT and magnesium infusions. They prep the site with the new Chloroprep (Chlorhexidine) rub back in forth for a few seconds then let dry for 30 seconds. I think this has even been proven to be better than the alcohol betadine route. But I am not sure. All I know is that with over 200 port sticks, no infection yet :) . CurleySue

nurselisER · Dec 24, 2004

yeah, in regards to resuscitation, i was always told its easier to cure an infection than death, so just get the IV in..........Bring them back and worry about the infection.

I can honestly say that I never did not prep a site, whether an arrest or other... but that's because of always preparing and setting up before the shift. (gloves, IV prep kits, etc. ) love to learn something new every day and I sincerely appreciate the wealth of knowledge, ideas, opinions, experiences and resources posted here... thanks!

Merry Christmas to all! Copy%20of%20wink.gif

EricTAMUCC-BSN, BSN, RN · Dec 26, 2004

I have thought the same. I haven't seen any astonishing information to believe otherwise, although I have to admit that I do see the convenience in those cute little chlorprep swabs. They are good for multiple sticks since there is chloraprep in the handle, rather than tearing open several alcohol pads.

I always thought alcohol was a good antiseptic?

bobnurse · Dec 28, 2004

I always prep the site, So dont get me wrong.....But you've seen in codes where you prep the site and then touch it 50 times to relocate the vein, thus contaminating the site once again. When i was in the military, everyone got one cannula. So we were told to reuse it if we missed. (this is in wartime, before people start freaking out). This was 13 years ago, so im sure things have changed, at least i hope so.

How often do you see people putting unsterile tape under a sterile dressing? I see so many nurses take the tape from their stethescope and secure an IV under the dressing. Ive also seen places where they only use tape, no opsite?

tiredfeetED · Dec 28, 2004

Bob you hit it right on the button...my understanding is a back and forth action creates friction with etoh pad..

After you have cannulated the vein PLEASE do not tape down your site with tape. cover your site with a sterile tegaderm first...that tape is not sterile and your site is contaminated again.

As for codes, preping your IV site is not your priortiy at that time! :)

nurselisER · Dec 29, 2004

Bob you hit it right on the button...my understanding is a back and forth action creates friction with etoh pad..
After you have cannulated the vein PLEASE do not tape down your site with tape. cover your site with a sterile tegaderm first...that tape is not sterile and your site is contaminated again.
As for codes, preping your IV site is not your priortiy at that time! :)

The sterile tegaderm first is exactly the way I was taught and the way I continue to practice as long as the supplies are available. An IV prep in a code would not be a number 1 priority obviously. Priorities are forever changing as do a pt's condition. Obviously If I was intubating my partner would be on the cardiac and IV end. If I'm doing the IV? Everyone gets a prep. It's an efficient "quickie" prep that most wouldn't notice... I have never seen any of the nurses in the trauma, or cardiac room NOT prep a site. That doesn't mean it hasn't happened.

Has anyone here ever lost a family member, child/infant to sepsis? Just curious.

geekgolightly, BSN, RN · Dec 29, 2004

alcohol is bacteriostatic

chlorhexidine is bactericidal

EricTAMUCC-BSN, BSN, RN · Dec 29, 2004

hmm... looks like alcohol is "bactericidal"

Bob, that is a good point you bring up about the tape.

"Alcohol

While very effective antimicrobial agents when used in sufficient concentration (60-90%), alcohols appear to act by rapid denaturation of biomolecules (DNA, RNA, lipids, etc.) essential to microbial growth and development. Alcohols prove very effective against a broad spectrum of microorganisms, including gram-negative and gram-positive bacteria, fungi, and viruses, including the HIV, hepatitis B, and respiratory syncytial viruses. Alcohol application provides the fastest and greatest reduction in microbial counts on the skin. A one-minute immersion, or scrub, with alcohol proves as effective as four- to seven-minute applications of other antiseptics and requires hours for the bioburden to return to pre-scrub levels. Bacterial resistance to alcohols at high concentrations is extremely low to almost non-existent.

...The list of antimicrobial agents commercially available as principal active ingredients for use in patient preoperative skin-preparation products is relatively short and currently includes alcohols, chlorhexidine gluconate (CHG), and iodophors such as povidone iodine (PVPI). Only two of these antimicrobial classes, 1) alcohols (specifically ethyl alcohol and isopropyl alcohol) and 2) iodine and iodophors, are currently classified Category 1 (safe and effective) and allowed for patient preoperative skin preparation under the FDA's Tentative Final Monograph for Healthcare Antiseptics.

-http://www.infectioncontroltoday.com/articles/121topics2.html

alcohol is bacteriostatic
chlorhexidine is bactericidal

bobnurse · Dec 29, 2004

Bacteriocidal = bringing death to bacteria

Bacteriostatic = restraining the development or growth of bacteria

So alchohol would be a bacteriocidal....It leaves nothing behind to prevent the growth of bacteria........

Chlorhexidine would be a bacteriostatic, as it prevents the development of bacteria growth, as does iodine.

Also, here is the statement of FDA approval for chloraprep in regards to scrubbing back and forth versus circular motion.

Q: Clinicians are taught to prep the skin using concentric circles, why did the FDA approve ChloraPrep for a back and forth application of the solution?

A: Phase III clinical studies demonstrated significant reduction of skin microflora with the back and forth application of ChloraPrep. The Intravenous Nursing Society Standards and Practice states that the antiseptic solution should be applied with friction. The American Association of Blood Banks recommends a procedure of mechanical friction in a side-to-side application for donor site preparation. This friction is achieved with ChloraPrep's unique applicator which works the solution into the cracks and fissures of the epidermal layer of the skin. By contrast, friction is difficult to achieve with swabsticks moving in a circular pattern. Without sufficient friction, antiseptic solutions may not penetrate into the cracks and fissures of the epidermal layer of the skin.

I had to use that literature to prove a nursing instructor wrong during a discussion (argument) in regards to proper use of a chloraprep swab...

bobnurse · Feb 11, 2005

Anyone else?

nurselisER · Feb 11, 2005

I clearly remember when all the IV carts were updated and having one of the nurses explain the rationale as stated above--however, I must say you put this together nicely. Thank you and have a great weekend....lisa

Anyone else?