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Wiping off IV ports

Nurses   (36,834 Views | 100 Replies)

blondy2061h has 15 years experience as a MSN, RN and specializes in Oncology.

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sauconyrunner has 11 years experience and specializes in Emergency.

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I almost exclusively have patient's with central lines at work, so scrubbing the ports before using them with an alcohol wipe is essential. When I do have a patient with a peripheral IV, however, when flushing it or connecting tubing I still scrub it with alcohol. I feel like this is how I was taught in school. My dad was in the hospital and people were constantly doing stuff with his IV, no alcohol wipe. I figured it was poor practice, but a short cut in a busy unit. Then I had to go to a different hospital for a CT scan, and there the nurse pushes contrast and connected fluids never using an alcohol wipe (except for insertion). Do you use alcohol wipes? Are they needed?

As an Infection preventionist.... let me tell a wee little story. yesterday I worked up 2 blood stream infections. They were both fecal bug/germs...eeeew....right and both came from peripheral lines. YES it is necessary. Both of these patients had extra hospital days, and lots of new antibiotics that they didn't come to the hospital for to fix what could have been prevented.

The IV caps are a new thing that is used at some hospitals. They are not cheap...and you have to replace them every time you access a port. We decided against them because they offerred no actual improvement to the current practice. It does not take long to scrub your hubs...and it can be done. Our ICU has not had a blood stream infection for 800 days. Guess who is scrubbing their hubs.

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sauconyrunner has 11 years experience and specializes in Emergency.

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The standard is .. wipe all ports, twice,, with a 15 second wait in between.

It is the drying time that kills any organism .. not the wiping action.

However,, that 30 seconds .. seems like a lifetime with every thing else we need to do.

It does seem like forever. But the fact is it could mean the difference between forever and not forever for an ill patient, especially one of those patients that picks at stuff...Patients can so easily contaminate their own ports, we do have to be super careful.

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ShantheRN has 4 years experience as a BSN, RN and specializes in Pediatric Hem/Onc.

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I kinda want the OP to name the hospital so I can avoid it lol Other than during codes, there is no reason to skip scrubbing a line.

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Asystole RN is a BSN, RN and specializes in Vascular Access, Infusion Therapy.

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The standard is .. wipe all ports, twice,, with a 15 second wait in between.

It is the drying time that kills any organism .. not the wiping action.

However,, that 30 seconds .. seems like a lifetime with every thing else we need to do.

Actually the studies show that scrubbing the hub for at least 15 seconds to be a more effective method. In fact, the scrubbing action is more important than the disinfecting agent that is used considering that many organisms are not killed by alcohol and alcohol has a difficult time penetrating biofilms.

This is sort of like hand washing, the type of soap is not important, it is the friction and duration of the scrub that removes the bacteria.

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Asystole RN is a BSN, RN and specializes in Vascular Access, Infusion Therapy.

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As an Infection preventionist.... let me tell a wee little story. yesterday I worked up 2 blood stream infections. They were both fecal bug/germs...eeeew....right and both came from peripheral lines. YES it is necessary. Both of these patients had extra hospital days, and lots of new antibiotics that they didn't come to the hospital for to fix what could have been prevented.

The IV caps are a new thing that is used at some hospitals. They are not cheap...and you have to replace them every time you access a port. We decided against them because they offerred no actual improvement to the current practice. It does not take long to scrub your hubs...and it can be done. Our ICU has not had a blood stream infection for 800 days. Guess who is scrubbing their hubs.

Dignity Health has recently converted to using he alcohol caps in all their facilities. I agree with you that 25 cents per cap is not cheap and is mostly used as a crutch for those not following best practices. That being said, a facility of any significant size will always have at least 1 nurse that does not follow through with procedure and a single CLABSI is very expensive. Last time I looked the average cost was around $25,000 per CLABSI, that equates to 100,000 caps.

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OCNRN63 is a RN and specializes in Oncology; medical specialty website.

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omg i hate it when i find tubing like that. the cap to your pre-filled ns flush fits the end of the tubing too, and that's sterile. i carry a few flushes around with me always (whatever, joint commission- explain to me how an ns syringe in my pocket is more cross-contamination than my cheat sheet or pens) and i end up using them as much for the cap as i do to use them for flushing. honestly, when i see tubing looped, i get upset because i don't feel right using that tubing- i have no idea whether the sleepy nurse last night scrubbed first. come on, the minute it takes to run for a cap vs. priming all new tubing!!!! let's just do the best thing for our patients.

i never saw tubing looped until several years ago, and the first time i saw it i was like "huh?" i have no idea why you would do that; just get a cap.

 

as far as scrubbing port, i really try to remember to do that, but i know i have forgotten occasionally from time to time. sometimes you just get so busy you don't realize you forgot something until after the fact.

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sandyfeet has 5 years experience and specializes in Emergency Nursing.

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What about when you draw up something from a vial-is it sterile once you pop off the lid, or do you scrub there too? In Fundamentals I was taught to scrub, but throughout all of my clinicals I can't recall ever seeing an RN do this.

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jelly221,RN has 3 years experience and specializes in Neurosciences, cardiac, critical care.

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What about when you draw up something from a vial-is it sterile once you pop off the lid, or do you scrub there too? In Fundamentals I was taught to scrub, but throughout all of my clinicals I can't recall ever seeing an RN do this.

I was taught that the rubber stopper is sterile under the cap, which makes sense considering how hard it is to pop some of those suckers off. Now that I think about it though, I've never checked manufacturer packing to see if it is actually sterile under there- does anyone know? I'll be reading some vials at work on Thursday :)

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jelly221,RN has 3 years experience and specializes in Neurosciences, cardiac, critical care.

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Using the cap from the NS flush to cap the end of a line is NOT appropriate. That isn't what the caps are designed for, and there is no research to show that this is effective. Don't be a lazy nurse. And if your facility is making you charge out every single sterile cap... maybe you can lobby them to show how compliance will be better (resulting in money saved for the hospital as infections are prevented and uncapped tubing doesn't have to be thrown away) if bulk caps can be available.

I know this makes sense and seems easy (I used to do it, too), but take some time to read at the Infusion Nurses Society website for more on the subject.

Huh I'll definitely check out their website, I used it as a resource for a poster presentation I did for our Skills Fair this year, and they had some great resources. Do you have any specific links to info re: saline flush caps?

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sauconyrunner has 11 years experience and specializes in Emergency.

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I was taught that the rubber stopper is sterile under the cap, which makes sense considering how hard it is to pop some of those suckers off. Now that I think about it though, I've never checked manufacturer packing to see if it is actually sterile under there- does anyone know? I'll be reading some vials at work on Thursday :)

I don't know for sure. I do know that Blood Culture bottles, even though they have a cap on them that has to be popped off should have the tops prepped before you use them....wonder if it is the same for medications. I think we are supposed to use alcohol, but I don't think I ever see anyone doing it.

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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Our pharmacy has told us to scrub the rubber hubs from anything with a flip top.

We vetoed the alcohol caps...to pricey for our facility when compared to an alcohol swab.

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grownuprosie has 1 years experience.

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I don't know for sure. I do know that Blood Culture bottles, even though they have a cap on them that has to be popped off should have the tops prepped before you use them....wonder if it is the same for medications. I think we are supposed to use alcohol, but I don't think I ever see anyone doing it.

My text says that not all manufacturers guarantee sterility under the top. So, you can check every time or just swab. I think it would probably take longer to track down the info than just to scrub.

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