Your NICU's protocol for cleansing IV ports

[minky84]

We are having a large number of nosocomial sepsis in our unit and I have volunteered myself for the research and protocol write. I was hoping you all could tell me what you all use for cleaning your ports prior to tubing changes, IV medication administration etc. What chemicals do you use? How long for the cleanse? In what order? Who is the company that supplies these to your unit? Also if possible is there research behind these products? Thank you so much in advance!!

Brennyn :)

[BittyBabyGrower, MSN, RN]

We use on kids over a kg...and sali-wipes after to prevent burns.

[nicurn-jenn]

When giving any iv meds we wipe with alcohol swab for 15sec and let dry, pretty standard across most hospitals. We access all med ports with sterile gloves. We change TPN/IL and tubing every 24 hours including med line if there is one. changing this tubing requires a sterile field and sterile gloves. Sterile gloves must also be used to connect it to the baby. For ALL line insertions we use a 2% CHG solution that is wiped off with a saline wipe to prevent burns. (which will happen, i'm on our skin care team and when this happens, although infrequent, its sad.) Every baby has their own bottle of the solution at the bedside and a brand new bottle is used with any sterile procedure being performed. Of course a sterile field with all central line insertions and dressing changes, also everyone in the room during a dressing change or central line placement must wear a hat and mask. All this is a pain, some of these protocols are newer, but our infection rates are low. So i guess its worth it in the end.

[littleneoRN]

I don't understand the sterile gloves for IV meds either. You are cleansing the port, which has not and will not be sterile. You shouldn't be touching the end of the port with your gloved hands, sterile or not. You should only be introducing a syringe which came from a sterile package and has since been capped. And you shouldn't have been touching the end of that either. I guess I just don't see the benefit there. Although we always have ways we can improve, I know that according to the VON data, our unit has a very low infection rate compared to expected for acuity. We definitely don't use sterile gloves. In fact, we string our own TPN non-sterile (just clean gloves and a clean surface, except for our highest risk patients, whose TPN is strung under laminar flow. We are sterile for line placements and dressing changes. We cleanse with chlorhexidine for both ports and skin prep on all babies except micros. Micros get betadine due to their skin fragility and increased absorption of chemicals through the skin. 30 seconds scrub, 30 seconds to dry.

[BittyBabyGrower, MSN, RN]

Many places add the total sterile gloves, etc when they are still having issues with infection. 99% of the time, line sepsis is caused by accessing the line for meds, draws, etc.

We are fanatical about cleaning ports...also remember to wipe your ports after you are done accessing also..esp if you are drawing bloods, bugs love blood!

[EmilyPeruana]

oh we have a whole algorithm....

but generally speaking, we use CHG b/f using a port...scrub 6x 360*...wait about 20sec for it to try...time sucks but it works b/c we've broken our own BSI records...

in terms of line changes, we do 2-person line changes q3d...we have one person be the sterile person...one be the clean person to hand everything to the sterile person or hook up things to flush...has worked ok for us so far...