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)?

[blondy2061h, MSN, RN]

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!

Call you insurance company, call you home care company. That's really all you can do.

In reality, port protectors are not necessary. They're a recent invention and people had central access devices before without them. Many hospitals still do not use them. They are really no better than adequately scrubbing the hub for 30 seconds with a cheap old fashioned alcohol wipe. They came to be because in rushed healthcare settings nurses were inadequately doing that. At home, you can make sure your husband gets prime hub scrubbing before each use.

[nutella, MSN, RN]

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.

Acute dialysis usually follows a much stricter protocol regarding PPE and access of dialysis line.

I can not remember that I have seen any of the green caps on the end pieces of dialysis central access lines. When dialysis and rinse back is completed and the catheter flushed, it is usually locked with heparin or citrate and a regular end piece screwed on. The catheter should not be accessed by non dialysis personnel for a variety of reasons - although a lot of facilities have a protocol that allows non dialysis nurses to access the catheter for emergencies for examples. Because acute dialysis usually cleans much more, pays special attention to aseptic technique they do not use the green caps. To connect the dialysis tubing, you need to remove the cap (unless it is the special Tego cap, which some chronic centers have adopted but not necessarily acute dialysis), scrub around the catheter with alcohol pads and connect to the tubing. Also, it has been my experience that I changed the central line dressing with mask and sterile dressing change kit and worked consistently to highest standard - you can't be sloppy in acute dialysis.

When acute dialysis is outsourced you also have to follow the hospitals P & P for precautions and cleaning of equipment between patients but a lot of times the dialysis P & P are much stricter.

I loved acute dialysis - was one of my favorite jobs ever!

Well - I love palliative care as well...