Scrub the Hub

Nurses General Nursing

Published

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?

Specializes in Hem/Onc/BMT.
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.

Sorry, I work BMT where patients walk the fine line between recovery and fatal sepsis daily with zero neutrophil count, where nurses absolutely have to be neurotic neat freaks so that our patients do not end up in ICU or even DEAD in the first place,... which is quite a considerable feat given that there tends to be a lot of vomitus and diarrhea around our patient population...

Look, Dranger, it's obvious you take a great pride in working critical care. How about grow up a little and recognize that no specialty is superior to another, and that nurses from different specialty will have different focus? Obviously no fool will spend 15 precious seconds scrubbing the hub when pt is coding. But your cavalier attitude is something that could truly kill a patient on our floor.

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Specializes in Inpatient Oncology/Public Health.

So with the swab cap you just take it off and connect your syringe or line? Awesome.

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So with the swab cap you just take it off and connect your syringe or line? Awesome.

Considering they are on average $0.25 per cap and are one time use disposables, expensive awesome.

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Specializes in Oncology.
So with the swab cap you just take it off and connect your syringe or line? Awesome.

Yep. They're very cool. My biggest issue is that since we got them they're mandated on any lumen/port/y-site. They do audits on it. Sometimes they fall off, and if it gets timed with an audit you're being counseled. They can be tricky to get on the lumens- at least the ones we have can be.

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Right?! Also, the "dude chill" thing is a big ridiculous. Just be nice and stop admonishing, reminding, and using weird little phrases! We are adults here, not children.

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Right?! Also, the "dude chill" thing is a big ridiculous. Just be nice and stop admonishing, reminding, and using weird little phrases! We are adults here, not children.

Dude chill, is admonishing? What is this 1956?

I was letting the guy know everyone makes mistakes and for him not to worry but I forgot every nurse on here is Florence Nightingale reincarnated and never makes mistakes. Please.

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Sorry, I work BMT where patients walk the fine line between recovery and fatal sepsis daily with zero neutrophil count, where nurses absolutely have to be neurotic neat freaks so that our patients do not end up in ICU or even DEAD in the first place,... which is quite a considerable feat given that there tends to be a lot of vomitus and diarrhea around our patient population...

Look, Dranger, it's obvious you take a great pride in working critical care. How about grow up a little and recognize that no specialty is superior to another, and that nurses from different specialty will have different focus? Obviously no fool will spend 15 precious seconds scrubbing the hub when pt is coding. But your cavalier attitude is something that could truly kill a patient on our floor.

Yup everyone gets a gold star like first grade or little league ;)

I am cavalier when some rando poster gets on here and tries to make the OP feel bad when he messed up once. I included that in EMERGENT times I have pushed drugs fast to save someone's life and they ended up going home a few weeks later without sepsis, bacteremia or endocarditis. Fatalistic finger waving does nothing for a guy who obviously feels bad and in reality adds NOTHING to the thread.

As for what can kill a patient, I have seen a patient die because they were too caught up in proper procedures and tasks to react quick enough when a patient was going down. Take your pick.

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Specializes in Hem/Onc/BMT.
Yup everyone gets a gold star like first grade or little league ;)

This is why I suggest developing a more mature perspective. I have no intention of going tit for tat, so I'll just stop there.

OP, none of us meant to make you feel worse about making that one mistake. We all make a mistake, it's true. When it comes to scrubbing the hub, however, there are ways to make it into as natural routine as not forgetting about your pants :D. It's very unlikely that your patient will suffer serious adverse outcome from that single incident. Nurses do sometimes omit (or shorten) scrubbing in emergencies where every second counts. There are, however, neutropenic patients, for whom you should always always keep aseptic technique when accessing their central lines.

I think that about sums up this thread pretty well, minus the petty arguments...

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I didn't realize the swab caps were so expensive. Now I feel a little bad about the ones that came home in my pockets and went through the wash. Even with the swab caps I still scrub the hub, especially if I wasn't the one who put it there. You never know if the previous shifts were replacing the caps or just putting the same one back on. I think they are only good for 24 hours and then they dry up.

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Specializes in Oncology.
I didn't realize the swab caps were so expensive. Now I feel a little bad about the ones that came home in my pockets and went through the wash. Even with the swab caps I still scrub the hub, especially if I wasn't the one who put it there. You never know if the previous shifts were replacing the caps or just putting the same one back on. I think they are only good for 24 hours and then they dry up.

Ours are good for a week if not removed. They're done the instance they're removed or after getting wet (if the patient showered). In all honesty, unused lumens need to be flushed at least q24h and caps and tubing get changed q4d so I don't understand how they could ever make it a week.

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Specializes in Emergency, Telemetry, Transplant.

To the OP: it was a mistake. It happens. It is not "no big deal" and you should learn from it, but it does happen. My guess is, at some point or another, every nurse has forgotten to (or was unable to R/T an emergent situation) scrub the hub thoroughly. There area few nurses here that are adamant that they have never not scrubbed the hub. I try to avoid "always" and "never," but maybe it is true, in these few cases, that they have always scrubbed (not just wiped) the hub. I don't know them or their practice so I can't say anything further.

I am a (definitely not hot-shot) ED nurse. In life or death situations, the hub is not properly scrubbed. Giving ACLS drugs are going to take precedence over the scrub. And yes, if a central line is being inserted, sterile technique is always going to be followed during said insertion. But it is not like we do not have other access--that is what IOs are for.

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Specializes in Cardiac/Telemetry.

Our hospital uses the swab caps for PICC and Central lines, love them. We have sterile caps for the end of IV tubing. I drop a few of both in my pocket along with alcohol wipes at the start of my shift and replenish as needed. These are great for when your patient has multiple IVPB's t/o the shift. My pet peeve is with nurses where I work who won't use the caps and leave me to have to fetch new secondary tubing, or they plug the end of the IV tubing when SL'ing into the Y site hub kinking the tubing into a figure 8. I've seen this done without wiping off the Y site hub and it makes me cringe. I am OCD about aseptic technique...

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