I work on an Onc floor with lots of central lines. My floor has just implemented a 1 minute scrub the hub before any access of the central line. If I'm understanding correctly, it would go like this:
1 minute scrub
Saline syringe flush
1 minute scrub
Pain medicine or lab or whatever
1 minute scrub
Saline flush
1 minute scrub
Considering they were having a hard time with compliance with a 30 second scrub, does this seem unrealistic to anyone else? They've ignored suggestions to prevent CLABIs like having a dressing change team but this is the solution?
I've suggested the caps and it's a no go. They are single use and expensive. More expensive than CLABIs? Good question.
We do central dressing changes often on my floor and always have two RNs present to ensure technique. But a team with a systematic approach and schedule seems to be key from what I've read on the subject.
The hospital I came from prior to my taking a position with our organization had a Vascular Access team. Their sole purpose was to put in PICC lines, ultrasound guided IV's, difficult peripherals, and ensure ALL central line dressing changes were done accordingly to proper policy and sterile technique.
Not surprisingly, that hospital had a very, VERY low incidence of CLABI.
Unless there is clear evidence to support doing a 60 second scrub, I don't see why the scrub time is now extended. After all, if it's an arbitrary thing just to get staff to do it for longer, it's not going to be any more effective than if they said 45 seconds. And if there's no evidence supporting the practice in the first place....why not make it a 90 second scrub? How about a 2-minute scrub? Will germs be "more dead" if you scrub for even longer?
They are going to need to staff us better if they want every IV encounter to take 5 minutes. That may not seem long until you have one patient's bed alarm going off, 2 others calling for pain and nausea meds, a dr waiting on the phone, and so on. If there isn't evidence to support extending the scrub time, what is the point?
We use the Curos caps now on all of our Central Lines. I personally love them. Haven't looked much into our clabsi rate as of late to see whether they have made a huge difference, but this reminds me to do so!
nynursey_
642 Posts
The hospital I came from prior to my taking a position with our organization had a Vascular Access team. Their sole purpose was to put in PICC lines, ultrasound guided IV's, difficult peripherals, and ensure ALL central line dressing changes were done accordingly to proper policy and sterile technique.
Not surprisingly, that hospital had a very, VERY low incidence of CLABI.