Scrub the Hub

[elemenRN]

There are no sterile caps stocked where I work. I wish we had some of those. Which do you think is better - scrubbing the hub on the same line and connecting it back onto itself, or connecting it to a needle and leaving a needle free-floating in the air (in a cap, of course)? I have seen it done both ways at my facility, although connecting the tubing back on itself is much more common.

How are there no sterile caps? That's crazy! Honestly, I have no idea what's better. You could use the cap of the sterile saline flush if you don't compromise its sterility? I do that sometimes...

And can we all just collectively cringe for the patient who disconnects himself and walks to the bathroom and you walk into the room to find the tubing laying on the ground still infusing? Ahhhhh!

[blondy2061h, MSN, RN]

I find it hard to believe you have never, not once forgotten to scrub a hub. I think it's ridiculous to accuse someone of not washing his hands just because he's been honest and said, "Yeah, I've probably done that once or twice."

I worked in oncology, and I'm sure that I forgot to scrub a hub at least once. Go ahead and cast stones.

Dranger didn't say that he/she may have forgotten once or twice. They made it sound like a regular practice, especially I'm emergencies, despite acknowledging that it's not best practice. THAT'S who my comment was directed it. And while all oncology patients are at high risk for infections, BMT patients are even higher risk, especially since I work in a unit that does very high risk transplants. Have I done things that aren't best practice before? Yes. I don't think I've done this particular one. Nor do I think it's good to justify it saying everyone does it.

[blondy2061h, MSN, RN]

How are there no sterile caps? That's crazy! Honestly, I have no idea what's better. You could use the cap of the sterile saline flush if you don't compromise its sterility? I do that sometimes...

And can we all just collectively cringe for the patient who disconnects himself and walks to the bathroom and you walk into the room to find the tubing laying on the ground still infusing? Ahhhhh!

I had a patient do that with her 5 lumen central line. I caught her when I nearly slipped on a puddle of TPN in her room. She died of sepsis.

[sweetdreame, BSN, RN]

Dranger didn't say that he/she may have forgotten once or twice. They made it sound like a regular practice, especially I'm emergencies, despite acknowledging that it's not best practice. THAT'S who my comment was directed it. And while all oncology patients are at high risk for infections, BMT patients are even higher risk, especially since I work in a unit that does very high risk transplants. Have I done things that aren't best practice before? Yes. I don't think I've done this particular one. Nor do I think it's good to justify it saying everyone does it.

If my family member is coding, don't even think about wasting 15 seconds scrubbing the freaking hub. Give the meds, the rest will sort itself out. Obviously you have never run a code.

[Dranger]

I haven't ever done that. You can't risk that in BMT, especially not in a central line that goes directly into the heart. I strongly recommend you change your practice. Carry alcohol in your pocket. It takes seconds and can save another emergency if your patient goes septic. Every time one of my patients becomes bacteremic, I wonder if there's something I could have done to prevent it. Do you also skip washing your hands?

Sorry, I work critical care where patients crash and burn on the daily and people are throwing syringes left and right to raise pressures/HRs in the 30s and bring back people from the DEAD. I highly doubt me not scrubbing as I bolused epi or levophed is the reason they went south.

Get off your high horse, we can compare medical/nursing offline if you want to call me out for something stupid. It will be quite amusing...to me at least.

[blondy2061h, MSN, RN]

If my family member is coding, don't even think about wasting 15 seconds scrubbing the freaking hub. Give the meds, the rest will sort itself out. Obviously you have never run a code.

Of course I have. I don't do a 15 second scrub but I at least wipe. And the vast majority of times aren't code situations. When they put in a central line in a code, they also still clean the site.

[LadyFree28, BSN, RN]

Of course I have. I don't do a 15 second scrub but I at least wipe.

...and that's how most of took Dranger's response...not "scrubbing"does not equal not wiping at all...

[Christy1019, ASN, RN]

Sepsis vs. Cardiac arrest.... Hmm well if its me, i'll take my chances with sepsis, gimme my epi stat! Lmao

To the OP, take a breath, it happens, I'm sure your patient will be perfectly okay!

[BSNbeauty, BSN, RN]

I'm one of those people who almost always scrub the hub. One of my biggest pet peeves is when I see nurses not do this in non-emergent situations in which I do hand them an alcohol pad. In fact, when I have my baby in December I'm going to keep a box of alcohol pads at the bedside and scrub the hub if I know the nurse is going to access it. If I'm in a code then I scrubbing the hub is not my first priority. I'm just being honest.

[Anna Flaxis, BSN, RN]

But, my question is, how probable is it that the patient will get sick?

Unfortunately, I don't think there is any way we can answer that question with any certainty. It really depends upon a lot of factors, like how contaminated was the hub? What is the patient situation, i.e. are they immune compromised, have they recently had surgery, are they on steroids, etc.

If you flushed first, then pulled your waste into the empty flush syringe, then that (when you accessed and flushed) would have been the most likely time for pathogens to have gotten in. If you were cutting corners like I've seen many do and didn't flush first but simply withdrew your waste, then the risk to the patient could potentially be lower.

If upon realizing that you had neglected to scrub, you immediately disconnected, scrubbed the hub, then reaccessed with a different (sterile) device, then you would have minimized any potential for harm.

To add to the general discussion, I am one of those nurses who will scrub the hub even in emergent situations. It only takes a few seconds (even a 3 second scrub has been shown to decrease bacterial burden), and I believe that we should do our best to avoid giving our patients iatrogenic complications when possible.

[blondy2061h, MSN, RN]

Sorry, I work critical care where patients crash and burn on the daily and people are throwing syringes left and right to raise pressures/HRs in the 30s and bring back people from the DEAD. I highly doubt me not scrubbing as I bolused epi or levophed is the reason they went south.

Get off your high horse, we can compare medical/nursing offline if you want to call me out for something stupid. It will be quite amusing...to me at least.

Your ICU sounds like a cluster if you're "throwing syringes" and don't have time for a 3 second wipe. Don't your monitor these patients and have some warning of an impending "crash and burn?" It would suck to save someone from severe bradycardia to have them die of sepsis a week latter. A good ICU nurse should be calm in emergencies, and not taking short cuts that only further compromise the chance of complete recovery. And yes, I work with critical patients too, so I do now how it is.

[OCNRN63, RN]

Dranger didn't say that he/she may have forgotten once or twice. They made it sound like a regular practice, especially I'm emergencies, despite acknowledging that it's not best practice. THAT'S who my comment was directed it. And while all oncology patients are at high risk for infections, BMT patients are even higher risk, especially since I work in a unit that does very high risk transplants. Have I done things that aren't best practice before? Yes. I don't think I've done this particular one. Nor do I think it's good to justify it saying everyone does it.

Yeah, I get that BMTs are at particular risk. I'm a certified oncology nurse and am internet-friends with someone who works at a world class hospital that does BMT.

You made it sound like never in your career as a nurse did you ever forget to scrub. With all the infusions we do over the years, I just find it hard to believe. It's less of an issue now that there are caps that clean the hub for us.