Port protectors and scrub the hub

[varc]

Our hospital has just switched to the SwabCap for port disinfecting. We were previously using the Site Scrub by Bard to scrub the hub prior to accessing the port and also before changing the end caps. The SwabCap is supposed to be applied to each needleless connector on the IV tubing and each central line/PICC port that is not in use.

The package instructions state "SwabCap will disinfect the valve 5 minutes after application and maintains a disinfected valve surface for up to 7 days if not removed". "Valve is ready for use. No further swabbing is necessary".

I may be paranoid but I don't trust not scrubbing the hub again before access. I like the idea that the cap protects the port from contamination between use but I don't trust that the cap has been in place the entire time or at least 5 minutes. I feel better if I scrub the hub in addition to the cap then I'm double protected against infection.

My hospital did away with the Site Scrub so I would have to use an alcohol wipe to clean before access. After MUCH discussion, I was asked to reach out and see if any of you felt as I do. Do any of your institutions use both procedures at the same time (port protectors PLUS scrub the hub before access)?

[varc]

I agree. It wasn't my decison

[Guttercat, ASN, RN]

I appreciate all of the comments. I did not mention that I am also an Infusion Nurse and responsible for educating the staff in best practices for infection prevention regarding IV/central/PICC lines. I was actually preparing to teach a class when this change came about so I am now charged with educating the staff that the SwabCap alone is what we are switching to. As I mentioned earlier, I like using them as a disinfecting port protector between use but for scrubbing the hub between needleless connector changes I prefer the SiteScrub. Also for our oupatient departmens like oncology and ambulatory surgery and even emergency department, I think the SiteScrub is a better option.

What is your facility's protocol re: dialysis central lines (dressings and accessing ports)? Any difference?

For many years now, dialysis has adhered to its own PP's, but it seems in the last couple of years it is more closely mirroring the host hospital's PP.

[OhioCCRN, MSN, NP]

EBP has proved that the caps (curos in this case) do help prevent CLABSI. (My unit has less than 1% CLABSI rate)

[RescueNinjaKy]

Not really relevant but I've seen the flushes with the scrub cap actually attached to one end of the flush and as a student I just think those are cool and fancy.

[varc]

Our dialysis unit is managed by a different company

[IVRUS, BSN, RN]

If you're just going to clean the port anyway, why bother with the expense of the caps? Might as well invest those $ in other nosocomial infection prevention programs.

Ahhh.... But since most experts agree that the majority of your CRBSI from catheters left in greater than a weeks time frame, are directly from inappropriate hub cleaning and manipulation of the hub, then having a cap on its end in between uses is a great safeguard. The 23-28 cents per cap, in NO way adds up to what CRBSI costs are.

[Beverage]

We use Swab Caps, I love them and do not re-scrub the hub. All central/PICC lines are supposed to be flushed q shift and have the swab caps changed with each flush at our facility. We also use blue sterile end caps for IV lines. If for example my pt is going to MRI, I have to HL/SL before they leave with transport. I use blue sterile cap to protect the IV tubing (I never plug the end into the port closest to insertion site) and swab cap on the port that is not being used while pt is off the floor.

[YuHiroRN, BSN]

In our facility (children's hospital), our policy says to scrub after taking off port protector, which is Curos for us.

[Karou]

Our hospital recently started using Curous caps for central lines after doing a trial first. I really like them, and they have significantly decreased our CLABSI rates. We also use the caps for the end of IV tubing, like between intermittent infusions and piggybacks. The problem is with compliance. Half of the time I come onto shift the IV tubing is missing the caps on all the connection ports (which we require), and/or there are no extra caps hanging on the IV pole.

[Beverage]

The problem is with compliance. Half of the time I come onto shift the IV tubing is missing the caps on all the connection ports (which we require), and/or there are no extra caps hanging on the IV pole.

The non-compliance by our staff drives me nuts! I hate finding the tubing twisted and connected to itself. I have a Preceptee who is getting extra practice in changing and priming IV sets. I carry extra caps

[FineAgain]

If you're just going to clean the port anyway, why bother with the expense of the caps?

Well for one thing, you can prove that the caps are being used by looking at the hub. You can't always tell when someone is cutting corners...or doesn't care.

I love the Curos and trust them. Our CLABSI rate has dropped as well.

[perkinsj]

I'm not a nurse (sorry), but I'm frustrated and needed to comment. My husband needs infusion for the next 6 weeks after his operation and we were sent home without any port protectors or wound care supplies (and the case worker never saw us upon his hospital release, so that's another issue). I was able to obtain 25 port protectors and can't get any more. On Amazon, they cost over $167 for a box. Why were we not supplied any and what can we do besides purchasing our own medical supplies? I was told not to reuse what we have and we also had to get our own wound care supplies! What's our health insurance for anyway? I'm in tears and beyond frustrated!