"Scrub the Hub" means... ?

Virgo_RN, BSN, RN · Dec 1, 2009

I'm guessing they really mean the cap, but "scrub the hub" is a lot catchier than "decrap the cap".

Dialysis R.N. in IA · Dec 1, 2009

I am not convinced my first attempt fully explained which portions I meant on the end of the line. Here is a picture I found:

Scrub the clear cap only, or remove the clear cap and scrub the blue hub?

Again, thanks.

HmarieD · Dec 1, 2009

Has to be the blue hub. What's the point of scrubbing the outside of the cap?

NewNurseCA · Dec 1, 2009

Hi, I'm a near-grad student in CA w/ lots of time in ICU w/ PICC and central lines-- so grain of salt, but here goes:

The hub IS the part that the syringe attaches to, at my hosp they have a blue core w/ a clear port around it. If there's a cap in the way of the syringe you're attaching, get it out of there before scrubbing-- you are disinfecting the part that the syringe attaches to.

Scrub the hub means: stick an alcohol wipe in your fingers, grab the hub that you will attach a syringe to, and squeeze back and forth as though you're juicing an orange: the orange being the alcohol. You do this back and forth either 30 times or for 15 seconds, depending on what research your facility prefers to use. I think of it like scrubbing people's skin w/ chlorhexadine in the OR: you are essentially sterilizing the area both w/ the alcohol, but mostly w/ the friction you create. Central line infections are being taken down to nil with this practice!

Incidentally, the research shows that there are far fewer infections via PICC's when pts are caring for them at home than there are in the hospital: this says to us that having fewer hands on a PICC keeps infections down, as does thorough hand hygiene/gloving when approaching a PICC, and ALSO being the person attached to the PICC, meaning you will take the whole 15 seconds to 'scrub the hub' because well: it's your health.

TigerGalLE, BSN, RN · Dec 1, 2009

You would remove the cap and scrub the part that you screw the syringe into... Or whatever you are connecting to the line. Then at the end of the dialysis treatment I would think you would get a new sterile cap.

ChocoholicRN · Dec 1, 2009

I am not convinced my first attempt fully explained which portions I meant on the end of the line. Here is a picture I found:
Scrub the clear cap only, or remove the clear cap and scrub the blue hub?
Again, thanks.

We actually use this slogan where I work, mainly intended for PICC lines but important for all IV's. In the picture you showed it is missing a piece, there is actually a port or hub that is attached when you remove the clear cap. The IV line or flush or whatever your injecting is attached to this hub. I can't find a good picture of it but I hope my explanation helped.

Dialysis R.N. in IA · Dec 1, 2009

Thank you, thank you, thank you. You all agree that the current practice of scrubbing the outside of the cap prior to removing that piece, but then not scrubbing the actual line hub is not proper technique.

Now if I can just find that in easy-to-understand terms from a policy or practice journal so that I can go about helping my coworkers stop the horrible infection rate our patients with central lines are experiencing...

NewNurseCA · Dec 1, 2009

Want some research? This slogan was used at my Hosp:

"SAVE that line!"

Scrupulous hand hygiene before and after contact with all vascular access devices and prior to insertion.

Aspetic technique during catheter insertion and care

Vigorous friction to hubs. Vigorous friction with alcohol wherever you make or break a connection to give medications, flush, change tubing or access injection port or add on device.

Ensure Patency- flush all lumens with adequate amount of saline or heparinized saline to maintain patency per institution policy.

from this site w/ plenty of other goodies: http://www.maximusmedical.com/understanding_bsi.html

My hosp had a core PICC resource team of about 4 RN's who did audits, posted colorful posters w/ slogans like the one above, etc. Might be a worthwhile in-service, or a 5 minute PSA at your next staff meeting? It's actually such a simple practice it's sort of silly to give it too much time. Good luck!

IVRUS, BSN, RN · Dec 1, 2009

Scrub the hub means cleaning the end of the injection cap (whatever kind it may be) for 30 seconds like a juicer, as a poster mentioned earlier.

Injection caps are removable and are the number 1 source of Catheter Related Blood Stream Infections (CRBSI), as shown in many experts studies.

Not scrubbing the cap, or failure to scrub it properly, and failure to change it on a routine basis, ie.. every 7days for a central line, causes major infections as all kind of organisms are waiting to jump onto the vascular system.

Is the picture you attached what your current employer uses on the catheter's end? Or, is there a cap with threads on it where the barrel of the syringe attachs too?

Dialysis R.N. in IA · Dec 1, 2009

The picture is a generic photo I found trying to illustrate what I am referring to.

I cannot find a single picture of the equipment we use, but I did not take note of the brand before posting.

I guess I will have to do more sleuth work tomorrow and update the question then.

My coworkers scrub the outside of the threaded cap on the end of the line (when it is not in use) before removing the cap... and then pop the syringe/dialysis line right onto it. I still maintain that underneath portion, which I would consider a "hub" needs scrubbed, too, as it is often covered with dried blood, etc.

Thanks for all input, links, and help!

ayla2004, ASN, RN · Dec 1, 2009

All our non dialysis lines now have self sealing flat caps that mean we can clean then with an chlorohexdine alcoloh wipe for 30 secs prior to acessing the line.

The dialysis lines the iv and infection control team are working on obtaining a product simialr to the other lines so it can be cleaned similar. i'm not an dialysis nurse so from the last update things may have changed to achieve this.