Pushing IV Meds Without Scrubbing Hub

[catl8y]

Something has been bugging me about the last shift I worked and I would just appreciate everyone's two cents. I was helping with another nurse's pt during an emergency situation in which the patient was experiencing brief periods of loss of pulse and consciousness. The episodes were so brief that she would become responsive again before compressions could be started. Pads were attached so we could have paced her if necessary. We had pushed epi and the MD ordered a dobutamine gtt. The patient's primary nurse handed me the end of the Dobutamine tubing to attach the patient as he programmed the pump, and I took a very brief moment to scrub the hub on the femoral CVL before attaching since prep pads were nearby. During this time, by the way, the patient was responsive and with a pulse. Long story short, a nurse who was watching from the doorway was like "just connect it you're stressing me out!" She didn't really mean anything by it, but I couldn't help but to feel a little embarrassed afterwards because there were like 10 people in the room! So what do you think, would you have spared the few seconds to scrub or no? 

[JBMmom, MSN, NP]

You did the right thing. Have I done the right thing every single time? No. But you're never wrong for doing it right. 

[RNperdiem, RN]

If you had the alcohol wipe right there, you did fine. If you caused a big delay going to find something to scrub the hub, then I would have a problem. Also, don't minimize how sick the patient is. He may be awake when you were given the line, but was actually coding right before and still in a dangerous situation. Nurse was probably feeling the stress.

[Been there,done that, ASN, RN]

Sounds like it was touch and go with  the patient, but waiting 15 more seconds to clean the port wasn't going to hurt anything. The infection... may have. Remember.. in a code situation every body is over reactive. Let  it go.

I would appreciate  some response to my personal situation. ( sorry not trying to hijack).

I am a loooong time nurse. I have been hospitalized twice in the last year. I never saw any nurse scrub the hub... before accessing a port.  Thought it might be a new protocol. 

[JBMmom, MSN, NP]

1 hour ago, Been there,done that said:

I would appreciate  some response to my personal situation. ( sorry not trying to hijack).

I am a loooong time nurse. I have been hospitalized twice in the last year. I never saw any nurse scrub the hub... before accessing a port.  Thought it might be a new protocol. 

On a central line, it should be scrubbed with alcohol prior to accessing the port. However, there are alcohol infused caps (ours are green), and if the hub is covered with that cap, sometimes nurses consider that to be a clean port and inject directly. 

On peripheral lines, it's never wrong to use alcohol before injecting and it is certainly a best practice, but not everyone does it. 

[catl8y]

Yes, if it was capped those caps have cleaner in them and it's okay. But if the end was just out then they should have cleaned it first!

[cretin, ADN]

We were told by our education team that even if the patient had the caps on their central lines, they still needed to be scrubbed. 15 seconds scrub and 15 seconds dry for alcohol scrub, and 5 seconds scrub and 5 seconds dry for prevantix scrub. Although in a code situation, I don't think I have ever seen anyone scrub anything for 15 seconds before injecting into the line!

[SmilingBluEyes]

It's right to always scrub the hub any time it is accessed.

[JKL33]

Random thoughts:

- Wouldn't worry about others' outbursts

- If remotely feasible yes I do the scrub (so that would be almost always), but....

- What I rarely see anyone do and I myself probably only do on a very slow day....is wait the dry time

- Loudmouths at the doorway should be excused from service at the Code if there is nothing useful for them to do. That behavior isn't ACLS protocol

- The part about whether the patient was responsive that particular few seconds is irrelevant

- There are situations where you do your best but no one is going to be harmed if things like this are not perfect. Or chances are quite low. Example: I try to scrub even when the patient is combative/flailing, but sometimes limbs are going everywhere and it's a situation where patient or others could get hurt and at some point when you can get the syringe near the port you figure the alcohol swipes you made before you lost your grip a few seconds ago (and the port might have theoretically might have touched something else since you did that) are good enough.

[Guest219794]

On 2/4/2022 at 6:22 PM, cretin said:

We were told by our education team that even if the patient had the caps on their central lines, they still needed to be scrubbed. 15 seconds scrub and 15 seconds dry for alcohol scrub, and 5 seconds scrub and 5 seconds dry for prevantix scrub. Although in a code situation, I don't think I have ever seen anyone scrub anything for 15 seconds before injecting into the line!

Are your educators educated?

Serious question.  Not an expert in the subject, but I am pretty sure the whole point of Curos is sterile access.  I am 100% that compliance with a 30 second prep of an IV has an minute compliance rate.

As far as the OP question- think about the amount of medicine delivered by a GTT in the time it takes to prep an IV.  It is not the same as a push drug.  Don't give your actions a second thought, particularly since they were generated by the peanut gallery.

[CommunityRNBSN, BSN, RN]

I like the advice you’ve gotten to “let it go”!  In a stressful situation I’m likely to blurt out “OMG hurry up!” or something similar. Most people aren’t at their most gracious when they’re stressed. I wouldn’t give it another thought, since it was just a thought she tossed off “in the heat of battle.”  If she came to you the next day and wanted to have a conversation about the pros and cons of scrubbing the hub, that’s only reason you need to consider it further.