Wiping off IV ports

Nurses General Nursing

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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?

We do. Our CVL infection rate has gone way down. In fact, our unit has only had one this year, and that was a result of a Munchausen, but unfortunately we still got dinged for it.

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Specializes in Oncology.

I'll have to look for articles and suggest this at our next meeting. I remember we tried caps with some kind of antibacterial built in, but they were so hard to connect syringes to that we got rid of them.

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Yes, it is needed. That is how you get an CLABSI.

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There are two basic studies on port disinfection. The first type states that the longer you scrub the cleaner the port (common sense I think), the other types say that alcohol is ineffective regardless of scrub.

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And with CHG, dry time is also important.

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There are two basic studies on port disinfection. The first type states that the longer you scrub the cleaner the port (common sense I think), the other types say that alcohol is ineffective regardless of scrub.

My lab instructor is rabid about keeping our education up with research. Could you point me to those studies to show her? I am sure she would be interested. Thanks!

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My lab instructor is rabid about keeping our education up with research. Could you point me to those studies to show her? I am sure she would be interested. Thanks!

I would if they were difficult to find but a quick internet search will bring up many of them.

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I would if they were difficult to find but a quick internet search will bring up many of them.

I see where you are going with this, but i did do an internet search. Most of the stuff that comes up is forums (not evidence). The other stuff is related to Surgical site prep, venipuncture, and blood cultures. They refer to skin asepsis, not scrubbing the hub. I also checked the CDC which does not come down on either side of the issue. All of my texts state to use alcohol and I would like to keep up with EBP if what I am learning is wrong.

Perhaps it would be more productive to suggest search terms rather than imply I did not make an effort.

If anyone knows where to find this research and would be willing to share, i would appreciate it. Thanks.

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Have you tried google scholar? I haven't looked for the info myself, so I don't know what terms would work, but google scholar has often given me some good stuff when I'm not somewhere that I have access to peer reviewed journal databases.

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I did not know about google scholar. I found some good info there. Thanks!

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Our hospital just rolled out these little caps that go on all ports. They have alcohol imbedded in them and they disinfect if left on for at least three minutes. Any port that is open should have one of these caps on at all times until ready for use (then a new cap gets put on). No need to wipe anymore if the cap was in place. It's very convenient. They are about halfway down the page on this link New Innovations to Keep Central Line Caps Clean

We use them on regular IV tubing and pigtails.

Prior to this our policy was to use alcohol wipes, scrubbing for 15 seconds.

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Specializes in Critical Care.
I see where you are going with this, but i did do an internet search. Most of the stuff that comes up is forums (not evidence). The other stuff is related to Surgical site prep, venipuncture, and blood cultures. They refer to skin asepsis, not scrubbing the hub. I also checked the CDC which does not come down on either side of the issue. All of my texts state to use alcohol and I would like to keep up with EBP if what I am learning is wrong.

Perhaps it would be more productive to suggest search terms rather than imply I did not make an effort.

If anyone knows where to find this research and would be willing to share, i would appreciate it. Thanks.

As far as I know, there's only one study comparing alcohol and CHG on hubs. It's not all that useful since it only compared the infection rate following the introduction of a CHG disinfectant to the rate prior to that point and was very poorly controlled; The rollout of their CHG based hub cleaner was accompanied by a change to a "scrubbing" technique (vs wiping) as well as an initiative to encourage hub-scrubbing and audits to ensure compliance, which we know will improve practice and reduce infection rates, regardless of the type of cleaner used. If it had included an alcohol control group, taking the same education and auditing measures as the CHG group, then the data might have been of some use,

Elsevier

In terms of scrub duration, the widespread use of the 15 second recommendation is one of the great embarrassments of (supposed) EBP. The recommendation was based on a single study (Kaler,Chinn) that wasn't even designed to look at scrub duration and didn't compare a 15 second scrub to other scrub durations. All it found was that on a comparatively weak inoculum, a 15 second scrub was sufficient, which people then took as meaning that a 15 second scrub was the minimum amount of time needed for adequate disinfection since another study found that a 3 second wipe was insufficient (a study that used a "wipe" instead of a scrub, and an inoculum containing a bacterial load 4 times that of the Kaler study. Subsequent studies on scrub duration that actually do look at varying scrub lengths (see below) have not supported the premise that a minimum of 15 seconds is required, and when you look at compliance rates with extended scrub durations, it's definitely worth making a recommendation that is not more than necessary.

"Scrub the hub": cleaning duration ... [Crit Care Nurs Q. 2011 Jan-Mar] - PubMed - NCBI

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