swabbing off iv ports or saline locks before hooking up fluids

rnlately · Nov 28, 2011

I am one of the ONLY ones on my floor that even bothers to swab the port and this is a wing full of immunocompromised patients. I cringe when I see a nurse pick up the IV tubing and port that has been dangling on the floor or that the patient has dragged from here to the other side of Mars and push a med or flush without swabbing.

IVRUS, BSN, RN · Nov 28, 2011

Actually standard of care would be using CHG, as alcohol doesn't do much more than move the germs around.

Not true... Alcohol (70%) has bactericidal and mycobactericidal activity. It will disinfect, and is cheaper than chloraprep. CDC lists alcohol as an acceptable cleansing agent. If all it did was to "move organisms around" they wouldn't encourage its use.

carolmaccas66, BSN, RN · Nov 29, 2011

I've seen SO many nurses in my career who do not swab at all. When I asked a student re this, she told me they don't teach it at her university. Apparently they don't do it with insulin shots, or heparin or anything else.

And I remember an instructor saying that alcohol doesn't kill all bacteria, it merely lessens the chance of bacteria getting into the blood stream. And why do you have to let it dry? We were never taught anything re that.

I always keep 5 or 6 alcohol wipes in my pocket - I get them at the start of my shift.

And I will always swipe - irregardless of what the so-called nursing professors at uni are now teaching.

wooh, BSN, RN · Nov 29, 2011

CHG does have to be allowed to dry. That's when it's killing the nasty stuff. Not sure on alcohol, because we don't use it. We're big believers in CHG.

http://www.infectioncontroltoday.com/articles/2005/02/infection-control-today-case-study-100333.aspx

I keep them in my pocket. Because even when I go and take them with all the stuff for giving a med, if I don't have some in my pocket, I'm going to surely drop the swab.

Cat_RN, ASN, BSN, RN · Nov 29, 2011

I am one of the ONLY ones on my floor that even bothers to swab the port and this is a wing full of immunocompromised patients. I cringe when I see a nurse pick up the IV tubing and port that has been dangling on the floor or that the patient has dragged from here to the other side of Mars and push a med or flush without swabbing.

Does your floor have a high rate of infections? I'm honestly curious because I've often wondered if there have been any studies on swabbing vs. not swabbing and resulting infections.

blondy2061h, MSN, RN · Nov 29, 2011

My hospital recently started stocking these nifty little Swab Caps that we use on all access sites on all of our tubing. The Caps have alcohol inside, and when you need to push a med or hook up a line, you just unscrew the Cap, push the med, then put on a new cap. Eliminates most of our uses of swabs.
These: http://www.excelsiormedical.com/swabcap.php

They also have flushes with the swab cab built into the end of the plunger.

So this is something that goes on the IV when it is not in use? Then you don't need to alcohol wipe it when you go to use it next? I am trying to figure out how this is easier than alcohol wipes, I guess.

blondy2061h, MSN, RN · Nov 29, 2011

I agree swabbing the IV port with alcohol is not negotiable. However, I'm a creature of habit. One of the most uncomfortable moments in my nursing career is when I stopped to swab the IV port before pushing the Epi during a code. I looked up to see a room full of shocked faces. I deserved it.
Obviously I don't attend many codes. I was enlisted during a shortage of nurses on a night shift. I still cringe when I think about that moment.

We still swab in codes. If they do make it back, they don't need sepsis to deal with then too.

blondy2061h, MSN, RN · Nov 29, 2011

I am one of the ONLY ones on my floor that even bothers to swab the port and this is a wing full of immunocompromised patients. I cringe when I see a nurse pick up the IV tubing and port that has been dangling on the floor or that the patient has dragged from here to the other side of Mars and push a med or flush without swabbing.

Do they also give injections and draw blood without alcohol swabbing?

MN-Nurse, ASN, RN · Nov 29, 2011

I have to confess there were times I didn't have an alcohol swab in my pocket and have hooked up the fluids anyway. I would never do that again. I would take the time to go get the alcohol swab

I understand where you are coming from, but I don't understand why people who screw up at work go around posting about it on public boards.

Double-Helix, BSN, RN · Nov 29, 2011

So this is something that goes on the IV when it is not in use? Then you don't need to alcohol wipe it when you go to use it next? I am trying to figure out how this is easier than alcohol wipes, I guess.

The swab cap screws on to all your clearlink caps in the IV line. When you want to use a port, you just take off the cap, attach your syring, push your med, flush and then screw on a new cap. The new cap stays on until the next time you access the line. So you don't have to scrub with alcohol and wait for it to dry before accessing the line. Once removed, the caps have to be thrown away. If they are left on, they can stay for 96 hours, the life of your IV tubing.

We use them in our hospital as well. The caps are small and it doesn't take much to pull them off. So the only time we don't use them is with a kid who might pull it off and try to eat it.

kat7464 · Nov 29, 2011

How can you not swab the port? What nursing school did you graduate from and what employer would not provide you the tools you need to complete your job? You wonder if your post is "weird". No, your question is weird. .....because patient safety is almost the foremost in a nurse's mind. I am only a home health nurse but today had to change the central line dressing on a patient that sleeps with her chickens. Guess what? I still had my alcohol to scrub the ports, despite the chickens. Grow up and have the supplies on hand you need to keep your patient safe. You have a license and have no excuse.

AnonRNC · Nov 29, 2011

Yes, not swabbing does introduce bacteria. I just read an article that studied this in vitro (the lab - no patients). Some hubs were not swabbed at all, some for 3 sec, 5 sec, and 15 sec. Then the hubs were flushed and the flushed solution was cultured on agar. The not swabbed had higher bacterial counts than the swabbed. Those that were swabbed longer showed progressively fewer bacterial colonies.

Alcohol or CHG caps are better than just swabbing because they PREVENT colonization of the hub.