Port-a-cath sterile access technique question

[S.N. Visit, BSN, RN]

I was taught in nursing school, after removing the EMLA cream, to use Povidone-Iodine first in a circular motion from inner to outer using 3 circles, then use alcohol prep to remove the Iodine in same manner. Recently I went to a con-ed class, and they told us to first use alcohol & scrub back and forth , zig zag and criss cross over the port. Then use the Povidone- Iodine in the same criss cross zig zag motion not removing the Iodine before inserting Huber needle. This has me wondering, how everyone else is doing their port access when chlorhexidine or chloraprep is not included in the kit?

[ChristineN, BSN, RN]

Interesting. I've never used Iodine. I always use chlorihexidine AND alcohol to clean around site. I'll be interested what other people recommend as I did recently take care of a pt that claimed she was allergic to the chlorihexidine.

[Ms.Motivatednurse]

The chloraprep/chlorahexidine is the first choice. If none available use alcohol ( starting at the insertion site working out in a circular motion for 30 seconds allow to air dry) and than apply the povidine iodine (applying the same way as the alcohol. I graduated last year so not sure how up to date the con-ed class was that you went to. So basically I was taught the same as far as the item process but a differ way of applying it!!

[Ms.Motivatednurse]

Interesting. I've never used Iodine. I always use chlorihexidine AND alcohol to clean around site. I'll be interested what other people recommend as I did recently take care of a pt that claimed she was allergic to the chlorihexidine.

Also that was another reason we were taught to use iodine (if our pt's were allergic to chloraprep)

[caroladybelle, BSN, RN]

Currently use chlorohexidine - better microbial with less irritation and fewer allergies. No concentric circles as you should scrub.

Betadine really is supposed to be permitted dry and left on - many places find pts get skin irritation , thus they clean it off but that really isn't very antimicrobial.

[leslie :-D]

Betadine really is supposed to be permitted dry and left on - many places find pts get skin irritation , thus they clean it off but that really isn't very antimicrobial.

that's how i was taught...alcohol then the beta, let dry.

haven't had sensitivity/allergic reactions either.

leslie

[roser13, ASN, RN]

As in all things nursing, various thought processes/procedures change all the time. Some current policies no longer even require masks for the nurse or the patient. When I was in nursing school, that was an absolute requirement. The solutions used and the manner in which they are used changed often.

Bottom line: Your facility will have an access policy that you should follow. Posters here may tell you that it "must" be this or that solution; the only "must" for you is to follow your facility's policiy.

[mappers]

We use Chlorahexadine and scrub, then allow to dry. We use Betadyne only if there is an allergy...concentric circles. I work in a chemo clinic and access ports all day long. Oh...we still use masks as well.

[NotFlo]

The alcohol works when there is friction involved. I was taught to scrub. Little circular swipes don't do much, it's the back and forth scrubbing/friction that get rid of the bacteria.

[Woodenpug, BSN]

It's about evidence based practice. I was taught the circular method. Sufficient studies convinced me that that was less effective than back and fourth scrubbing. I'm a hard sell but the evidence shows that circles are less effective.

Betadine or iodine was believed to be better because even after it drys, it is still bacteriostatic. The problem is that is only the superficial layer of skin.

[Emergency RN]

I was taught in nursing school, after removing the EMLA cream, to use Povidone-Iodine first in a circular motion from inner to outer using 3 circles, then use alcohol prep to remove the Iodine in same manner. Recently I went to a con-ed class, and they told us to first use alcohol & scrub back and forth , zig zag and criss cross over the port. Then use the Povidone- Iodine in the same criss cross zig zag motion not removing the Iodine before inserting Huber needle. This has me wondering, how everyone else is doing their port access when chlorhexidine or chloraprep is not included in the kit?

One of the more 'refuses to die' notions from stone age nursing was the idea that somehow, by spiraling outward (not really 'concentric' circles as the motions are not equidistant), we can clean an area better or have superior antimicrobial action. The premise was if we can push dirt (which can harbor bacteria) furthest away from the biologically sensitive point of insertion, that this will assist in killing bacteria.

IMHO, the idea is rather quaintly Victorian.

Alcohol, iodiphor solutions or biguanides (like chlorhexidine), works by direct contact with microorganisms. That is, the germs must be made to bathe in it; by gently drawing an imaginary spiral outward from the target point of the port, there is the possibility that bacteria may actually hide in a microscopic crack or crevice, or under a dead layer of skin. Vigorous scrubbing with ample solution (whatever you use isn't the issue, technique is) and waiting for it to fully dry, allows for optimal antimicrobial effect.

Hence, ensuring the highest probability that the solution actually comes into direct contact with all the germs near the port is the most effective antiseptic prep method. Drawing outward spiraling circles may rationalize and satisfy some imaginary physical construct, but it has nothing to do with clinical microbiology.

***Sidebar*** For a really informative article on how modern chemicals fight germs, see here:

Antiseptics and Disinfectants: Activity, Action, and Resistance

[Scarlette Wings]

found this thread here on alnurses, it even had a video.

it may help.

the education for new nurses at our facility does not include providine iodine any longer because of the new research on chg. the circular motion is also no longer used. the zig-zag and back and forth method with friction are used. there is a great deal of importance placed on the time spent cleaning and allowing the area to dry along with hand hygiene, gloves, gown, and a mask for the nurse accessing the site are also stressed. we also have our patients mask.

https://allnurses.com/patient-education/procedure-accessing-portacath-418832.html