IVP meds- is this safe?

AJJKRN · Jan 26, 2015

I am curious if the way your preceptor is teaching you sounds reasonable to you or not and what else you are questioning that is pretty basic "real world nursing" things. Does this sound safe to you, does it not? Are you really over thinking this or do you not trust your preceptor? I'm not saying to follow everything your exposed to and taught just blindly but what about these steps are causing red flags to pop up in your head?

Gooselady, BSN, RN · Jan 26, 2015

Yep, this is really and truly small potatoes, unless you lick the port or sneeze on it in between changing the pre-sterilized syringes.

Gooselady, BSN, RN · Jan 26, 2015

Here's another way to look at it; what are the chances of a FLYING bacteria or virus body (latter more likely unless it's TB) to land on the port in the second it takes to replace a sterilized syringe to the port?

In general, it takes more than one viral body or bacteria to cause an infection. I'd worry a little more about a patient who's just been irradiated and given a bone marrow transplant, but in general, the chances of causing an actual infection is . . . abysmal

Nursing is definitely full of funny little 'rules' and OCD 'routines' that we nurses are conditioned to treat like the Ten Commandments -- don't even THINK about not following these rules!

But you need to think. And when you do think this through, OP, I think you'll see that you have LOTS of room to think this through and find pretty much nothing to go on about :) Still, good for you to be so conscientious. Just watch how intrusive and ridiculous it can get to be if your conscientiousness gets resentful of other nurse's practices . . .

IVRUS, BSN, RN · Jan 26, 2015

The "accepted" practice may differ from facility to facility, but in the world of infusion, one SHOULD scrub with EACH and Every access. Therefore, If you are getting ready to access a needleless connector, scrub well like a "juicer". Then hook on your saline syringe, obtain a brisk blood return, and flush with the saline solution. Disconnect the NS syringe, and scrub again. Then hook on your IV med, administer it over the appropriate time frame, then disconnect, and scrub again then saline syringe flushing, scrub and heparin flush if needed.

mariebailey, MSN, RN · Jan 26, 2015

That is how I do IVP meds. I just let the saline flush lie attached to the patient's IV port while I get the med ready, then keep the med syringe attached while I get the final saline flush ready. The important thing is to not take a flush/syringe off and consequently let the port just dangle free (touching things like patient skin) in between. An exposed port needs to be cleaned again. I was taught to do this by a good nurse; I trust her judgment.

SierraBravo · Jan 27, 2015

Are we talking about central lines? If so, for those who don't clean the hub each and EVERY time, I'd be interested to see your CLABSI rates. Are you seriously going to risk your patient getting an infection just because you want to save 10-15 seconds of scrubbing the hub each time it's exposed?

mariebailey, MSN, RN · Jan 27, 2015

Are we talking about central lines? If so, for those who don't clean the hub each and EVERY time, I'd be interested to see your CLABSI rates. Are you seriously going to risk your patient getting an infection just because you want to save 10-15 seconds of scrubbing the hub each time it's exposed?

sslamster, our ports are always covered with curos caps, which is an upscale version of scrubbing the port. Also, there is minimal risk if the port remains capped with a syringe and is not just left to fall exposed on the patient's arm in between flushes and med administration.

IV Port Access Disinfection - Needleless Port Protector | CurosÃ‚Â®

IVRUS, BSN, RN · Jan 27, 2015

sslamster, our ports are always covered with curos caps, which is an upscale version of scrubbing the port. Also, there is minimal risk if the port remains capped with a syringe and is not just left to fall exposed on the patient's arm in between flushes and med administration.
IV Port Access Disinfection - Needleless Port Protector | CurosÃ‚Â®

Please remember that the ONLY thing that that port protector does, is prevent you from having to do the INITIAL scrub of the needleless connector. After the cap has been removed and thrown away, one should scrub vigorously between connections.

Gooselady, BSN, RN · Jan 28, 2015

Alcohol must 'sit' in a liquid form on an object for 20 - 30 seconds to kill 70% of the bacteria present (I'll look for this reference, don't have it on this 'puter). The alcohol scrub itself is not a 100% disinfectant.

This is also a matter of common sense, as most of our evidence-based practice proves to be.

Does anyone have any links to evidence-based practice for scrubbing the port before AND between sterile syringes? I'm not challenging at all, I'm totally willing to change my practice if there is!

Graduatenurse14 · Jan 28, 2015

Are we talking about central lines? If so, for those who don't clean the hub each and EVERY time, I'd be interested to see your CLABSI rates. Are you seriously going to risk your patient getting an infection just because you want to save 10-15 seconds of scrubbing the hub each time it's exposed?

I should have been more specific. I mean peripheral IVs not central lines.

IVRUS, BSN, RN · Jan 28, 2015

Does anyone have any links to evidence-based practice for scrubbing the port before AND between sterile syringes? I'm not challenging at all, I'm totally willing to change my practice if there is!

From M.Ryder:

Vascular Access...Connection Without Infection!

Check out slide 88, 89, and 91 on best practices. This entire presentation is fabulous and truly informative. Ms. Ryder recommends cleaning every time and she really is a guru on infection control issues and vascular access devices. Since Biofilm is present on the end on every needleless connector, why just scrub once? A good juicing "motion" may be of enormous assistance in preventing bacteria from entering the cap. And of course, having the right cap, and taking care of it appropriately is essential.