Scrub the Hub

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So last night I was doing my standard shift routine and I was getting ready for blood draws. They all went well except on one blood draw I forgot to scrub the hub of the CVC before I accessed it. I didn't realize that I did it until I was more than half way done with all of my vials I needed. I felt so stupid because that is such a simple thing to forget and I feel really guilty... But, my question is, how probable is it that the patient will get sick?

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.

I love those self-cleaning caps. We used Curos my last semester of school. I'm impressed by simple things :)

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Specializes in Oncology.

We have the self cleaning caps too. They're fantastic.

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Specializes in ICU.

I LOVE LOVE LOVE the swab caps...they are required for use on all PICC/central lines at my facility, and I use them on PIVs as well if I know I'm going to be pushing a lot of meds through them.

For those who use swab caps - do you only use them on flushed/locked ports and lumens, or do you also use them on the Y-sites of your IV tubing? Just curious...my facility recently changed the policy and I'm wondering how it compares with other facilities.

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Specializes in Oncology.
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.

Are you a newer nurse? The reason I ask is that I think most nurses, after some years of experience, are humbled by our humanness and tendency to make mistakes. We become less judgmental and more compassionate for other nurses, because we know that there but for the grace of God, goes us. I can't think of a time that I haven't scrubbed a hub, because it's ingrained in me, but I wouldn't say for certain that I've never made that mistake. Even if I haven't made THAT particular mistake, I'm in no position to cast stones at others. Unless you've walked a mile in another poster's shoes, I would refrain from judgment on his or her clinical practice. To insinuate that he does not monitor his patients, and that's why they code is not only surely not true, but a really awful thing to say. Why do you think patients are in the ICU? They're sick, they're unstable. Pride comes before a fall... Perhaps you should keep to watching your own patients instead of watching the practice of others.

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Specializes in Inpatient Oncology/Public Health.

What are swab caps? I've never seen one.

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What are swab caps? I've never seen one.

You haven't seen them because they are expensive and many hospitals don't use them because of that.

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I think there is a difference between forgetting to scrub a hub every great once in a while, and consciously disregarding hub decontamination and rationalizing it.

We all screw up every once in a while- none of us is perfect. Well, except for me, of course. But I cannot advocate for disregarding procedures designed to protect the patient from harm just because you're in a hurry.

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Specializes in Vents, Telemetry, Home Care, Home infusion.
What are swab caps? I've never seen one.

SwabCap is a simple twist-on device that is intended to be used between catheter-line accesses as a supplement to manual disinfection--must be luer-loc connector. This device passively disinfects the connector top and threads as cap contains 70% Isopropal Alcohol.

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Specializes in Oncology.
Are you a newer nurse? The reason I ask is that I think most nurses, after some years of experience, are humbled by our humanness and tendency to make mistakes. We become less judgmental and more compassionate for other nurses, because we know that there but for the grace of God, goes us. I can't think of a time that I haven't scrubbed a hub, because it's ingrained in me, but I wouldn't say for certain that I've never made that mistake. Even if I haven't made THAT particular mistake, I'm in no position to cast stones at others. Unless you've walked a mile in another poster's shoes, I would refrain from judgment on his or her clinical practice. To insinuate that he does not monitor his patients, and that's why they code is not only surely not true, but a really awful thing to say. Why do you think patients are in the ICU? They're sick, they're unstable. Pride comes before a fall... Perhaps you should keep to watching your own patients instead of watching the practice of others.

No, I'm an experienced nurse. I would never judge someone for making a mistake, including the OP. I've made my fair share of med errors, including one that could have been potentially quite serious. I've made my fair share of minor, stupid mistakes. I do not think I have made this particular mistake. I do not think it's okay to justify risking infection in your patient because you're a hot-shot ICU nurse.

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Specializes in Critical Care/Vascular Access.

To the OP, there's no way to give you any accurate idea of what the likelihood is of that patient having complications from that one time you didn't scrub. There are a lot of factors to consider besides that one. I'd still guess the likelihood is fairly low, but either way it's definitely a situation to learn from.

As for the rest of the conversation on this thread, in emergent situations where a patient needs something immediately and seconds are counting, I still do a quick swab. If I happened to not have any swabs on me and I had to choose between leaving the critical patient to go get a swab or pushing meds through an unscrubbed hub then sure, I would opt to push the med.

As for "everyone" forgetting to scrub every once in a while, that's just not true. Of course I've made my share of mistakes on the floor, but I can say confidently that forgetting to scrub the hub has not been one of them. To me it would be like forgetting to pull down my pants before going to the bathroom, it's just an ingrained part of the routine.

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Specializes in Critical care.
To me it would be like forgetting to pull down my pants before going to the bathroom, it's just an ingrained part of the routine.

Ok, now you're just showing off! I guess you always open the screen door before walking through it, too. ;)

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Specializes in Hem/Onc/BMT.
To me it would be like forgetting to pull down my pants before going to the bathroom, it's just an ingrained part of the routine.

How funny, I was going to comment how I don't forget to swab just as I never forget to put on my pants before walking out of my house. You beat me to it with the "pants" analogy!

Yes, it should be a completely ingrained part of the routine. But sometimes interruptions happen and that's when the "routine" gets broken. If I ever forgot to swab, I was probably interrupted by something and resumed the task in the middle.

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