Not Cleaning Site?

[smiler2010]

Hi guys! I have a question? I had a fellow nursing friend who approached me with this scenario? In an outpatient clinic a patient received a PIV in her hand. The nurse who inserted the IV forgot to clean the site prior to IV insertion. The catheter stayed in for approximately 3 hours! What do you think this patient's risk would be?

[iluvivt, BSN, RN]

There are a few factors to consider here. First the skin is the first line of defense and cleansed or not it has been broken. The good news is that peripherals have a lower rate of infection for a variety of reasons. The bacteria count is considerably lower than on the chest and neck and groin. The resident bacteria are also different than in other areas such as those mentioned and less virulent. There is also less sweat and oil glands than other areas and the skin is cooler. All of these things will keep the rate of infection very low. There are other patient specific factors as well that would increase the patient's risk. For example. patients who are immunocompromised,diabetics that are not well controlled,patients with primary immune deficiencies to name a few.

I would take the PIV out an restart it if I was in that situation. Although I can remember a few dozen codes when I just did a quick swipe of a prep if I even could do that. You can always treat an infection but if the patient dies because noone could get a line in fast enough you never get the chance.