Wiping off IV ports

[blondy2061h]

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?

[wooh, BSN, RN]

I don't use the caps, I just think the logic of "it's single use only" isn't the best rationale. Meh, whatever.

[jelly221,RN, MSN]

But if you don't set it down, the part that will connect to the tubing hasn't touched anything. Except air, which your IV cap out of package is going to touch air.

And actually to just nitpick, our syringes aren't considered sterile, even in the package. The inside is, but you can't dump the syringe onto a sterile field. Just so someone doesn't go and think that in the package necessarily means the whole syringe is sterile. But that has nothing to do with the screwing part of the cap being sterile. Before or after it comes off the syringe. :)

Of course when I used (past tense!!) the flush caps I didn't set them down - I would take it off the syringe, hold it and screw into the end of the tubing.

Touching air doesn't make things un-sterile!! If it did, the OR wouldn't be a pleasant place to work!!

[healthstar, BSN, RN]

Hell yeah, I wipe and scrub the ports for at least 15 secs. Not wiping is poor practice! High risk for infection! Believe a true definition of laziness is not taking 15 sec to wipe ports :)

[wooh, BSN, RN]

You can rationalize it all you want, it still is bad practice. Just follow best practices and grab an actual sterile cap.

You sound like the people who argue why they do not need to gown and glove when entering an isolation room, " Buuuuuut, I'm not going to touch anything." Lol

Since you went there, if you go in the room and you don't touch anything, the gown and gloves were just a waste of time and money. MRSA doesn't fly across the room from the bedrail to what you're wearing.

You sound like the people that don't have a real rationale and think, "Because I said so" is a good reason.

[wooh, BSN, RN]

And wiping with alcohol, you might as well wipe with a wet paper towel. CHG is the ONLY way to go. :)

[student987]

The "scrub during a code" question came up in my lecture. The instructor responded with, "what is worse, an infection or death? There is your answer." makes sense to me.

Ya that was making me think of a trach pt who's trach pops out and there is not a spare in there....when asked is it ok to put the old one back in in that case clinical instructors response....well one is an infection risk but the other is a death risk so yes.

[dudette10, MSN, RN]

And wiping with alcohol, you might as well wipe with a wet paper towel. CHG is the ONLY way to go. :)

Can't tell if you're being sarcastic or not, so...

In micro four years ago, we did culturing of our fingertips and anything else we wanted to culture. Nasty stuff. Anyhoo, we used alcohol wipes on our fingertips, let it dry, and pressed them to the culture medium in the dish. No growth after three days.

In other matters, I have to agree with others about using the flush caps. If they aren't sterile when you first remove them from the flush, then the saline is contaminated anyway, and none of this matters, right? I also don't set it down if I'm going to use it as a cap for the tubing. Disconnect from IV at patient, uncap flush, put cap on tubing, burp flush, flush with saline. Dexterity is important here!

Our facility doesn't even keep sterile caps on the floor.

[Asystole RN]

Since you went there, if you go in the room and you don't touch anything, the gown and gloves were just a waste of time and money. MRSA doesn't fly across the room from the bedrail to what you're wearing.

You sound like the people that don't have a real rationale and think, "Because I said so" is a good reason.

Not adhering to set infection control interventions, regardless of rationale, demonstrates poor discipline. Gowning and gloving should become a matter of habit, not a matter of rationalization.

Let those who pay for the supplies worry about supply costs, they are the ones who have to make the cost/benefit decision.

[Asystole RN]

And wiping with alcohol, you might as well wipe with a wet paper towel. CHG is the ONLY way to go. :)

I would agree with you that CHG is the superior antiseptic due to it's ability to persist upon the skin and the ability to withstand organic contact but I would not liken the alcohol to water. Utilizing friction for a sufficient length of time (>15 seconds) is far more important than the antiseptic utilized.

[MunoRN, RN]

Not adhering to set infection control interventions, regardless of rationale, demonstrates poor discipline. Gowning and gloving should become a matter of habit, not a matter of rationalization.

Let those who pay for the supplies worry about supply costs, they are the ones who have to make the cost/benefit decision.

Actually gloving and gowning just to enter the room is not considered good practice. The CDC guideline is to glove and gown when coming into contact "with the patient or the patient's environment." It was once thought that the best thing to do would be to go the extra step and just require everyone to glove and gown before going in the door in order to ensure compliance, although what we've since learned is that this actually produces worse outcomes in patients. Patients on contact isolation receive a lower standard of care; they're less likely to have a Nurse just "eyeball" them and ask questions, a simple yet potentially life saving assessment, which is why the new trend is to create a path from the door to a spot in the room where the patient can be visualized and communicated with without the need to gown and glove - not to remind Nurses to gown beyond that line, but to encourage them to come into the room without the hassle of gowning.

I have to agree with Wooh, "because I said so" should not be the basis of why a Nurse does anything. I always cringe when I hear people say "just follow your policy". Far more important than just knowing the rules and blindly following them is knowing the 'why', including what the evidence actually says, what it doesn't say, and how strongly it says it, only then can you practice optimally.

The 15 second scrub is a good example, so just what is the evidence and how strong is it?

[wooh, BSN, RN]

The 15 second scrub is a good example, so just what is the evidence and how strong is it?

We were actually shown a comparison between scrub with CHG for different times, then the 10 second time with a 10 second dry time. (Our policy.) 10 second scrub gets rid of a lot. Give it time to dry, gets rid of a lot more.

[blondy2061h, MSN, RN]

Wooh- do you have CHG wipes similar to alcohol wipes at your facility? We don't.

I am amazed at how long this thread has gotten.