quick cap change question

[sweetieann]

Are central line/PICC cap changes sterile or clean technique? I see a policy stating to don non-sterile gloves to change, and my preceptor told me the same thing...but I always thought it would be sterile (I know the actual dressing change is sterile).

Thanks!

[WalkieTalkie, RN]

Well, at my hospital, we do it when we are doing the sterile dressing change, so technically we are still sterile when we get to changing the caps. However, it is nearly impossible to remain sterile and change the caps since the lumens themselves hang outside the sterile part of the dressing. I usually swab them with an alcohol stick and then allow them to dry before replacing them with sterile caps right after I have done the sterile dressing change.

[kmoonshine, RN]

I don't change caps often (I usually just prime the caps when initially placing a central line in the ED, or I will change the cap if someone comes to the ED with an indwelling line that has dingy old caps). However, here's my thoughts on it:

When you prime the new caps, you shouldn't be touching them at all (slightly open the package, screw the flush on, and pull the cap out from the package using the flush). Prime the new cap, hold the catheter line with your non-dominant hand, unscrew the old cap (make sure the line is clamped first), remove the sterile end to the new cap, and then screw the new cap into the catheter line. Unclamp the line and push-pulse flush the line and re-clamp it.

Sterile gloves or non-sterile gloves, if you do the technique correctly you shouldn't have a problem. If you're new to this, keep the cap in the package until you are ready to actually put it on (rather than balancing a sterile cap attached to a flush with one hand as you remove the old cap).

You could use sterile gloves, but the outside of many pre-packaged flushes are not sterile (even if they are in the package; just check the outside label which will say "do not place syringe on sterile field"). So, you can wear sterile gloves but as soon as you touch the flush, you've broken your sterile field and you are now contaminated. I guess you could make it into a much more elaborate procedure with sterile drapes, saline vials, and an assistant - but its really not necessary as long as you keep the caps sterile (basically, don't touch the top of the cap's luer-lock with your gloves; just immediatly attach the saline flush so it is connected and there's minimal risk of contamination).

Again, this is just my thoughts on the issue. Be sure to follow policy/procedure at your facility.