Your NICU's protocol for cleansing IV ports

[minky84]

We are having a large number of nosocomial sepsis in our unit and I have volunteered myself for the research and protocol write. I was hoping you all could tell me what you all use for cleaning your ports prior to tubing changes, IV medication administration etc. What chemicals do you use? How long for the cleanse? In what order? Who is the company that supplies these to your unit? Also if possible is there research behind these products? Thank you so much in advance!!

Brennyn :)

[karnicurnc, MSN, APRN, CNS]

We do a vigorous scrub with chlorhexadine (chloraprep) with line changes and use alcohol on PIVs before accessing a port. We use betadine on central lines before accessing, although all are supposed to have a dedicated med line.

[BittyBabyGrower, MSN, RN]

Go to IHI.org and do a search on central line bundles. We implemented a bundle 2 years ago and have cut our central line infections by 80%...we still have them, but not like we did! We have had zero infections in our UACs and UVCs since implementation. It is a huge process to change, and you will meet a lot of resistance to the changes, but they do work! We even inserviced our RTs, docs, NNPs, etc...anyone that had anything to do with a line.

[NeoNurseTX, RN]

We use chloraprep. Scrub 30 secs, dry 30 secs...every.single.access. We also have 2 people that change all lines except PIVs and currently giving all meds that are via PICC. http://www.pdipdi.com/images/products/chlorascrub_swab.jpg

[babiesRmylife]

our protocol for IV starting is sterile gloves, cloraprep scrub for 30 seconds, let dry before attempt. Change sterile gloves for each attempt!!

IV HUB/midline/UAC/UVA, etc.- we use sterile gloves & alcohol preps sterile, scrub for 15 seconds before inserting anything into the hub. Be sure to scrub not only the hub but as much as the alcohol "wipe" will cover & scrub vigioursly (spell check).

When we change IV tubing such as new TPN's we do this with 2 people. Lay down a sterile drape & proceed to run the TPN through the line. Discard old TPN & tubing connected to IV clave. Place your new TPN through your IV machine & keep the end of the TPN line that connects to your IV clave on a new sterile drape thats placed inside your bed. Put on new sterile gloves, scrub your hub for 15 seconds with alcohol prep, let dry. the 2nd person puts on sterile gloves & will take off the end cab to your TPN & then you can connect your TPN to your IV clave. Be sure to keep the IV clave you scrubbed off sterile & the IV tubing that you will connect into the IV clave sterile during this process.

We have had high infection rates which is what brought about this "radical" change in things. Our current infection rate over the last couple months has been 0% for all lines!

[kittykai]

We just use ETOH wipes. Scrub for 30 seconds and wait til it dries. We do this on all of our ports prior to infusing meds. All of our surgical babies have their tubing changed every day and nonsurgical babies every three days. The only time we do any sterile procedures is for starting UVCs, UACs, PICC lines, and broviacs. Of course when we are changing the cressing for these lines they are sterile as well. We do not have high infection rates at all. Maybe one every six months or so. We are sticklers for good hand hygeine. Clean hands equal healthy babies and nurses.

[dawngloves, BSN, RN]

IV HUB/midline/UAC/UVA, etc.- we use sterile gloves & alcohol preps sterile, scrub for 15 seconds before inserting anything into the hub. Be sure to scrub not only the hub but as much as the alcohol "wipe" will cover & scrub vigioursly (spell check).

You don sterile gloves every time you give an IV med??

[babiesRmylife]

yes every time we give an iv med or even flush an iv we use sterile gloves

[nurse2teach]

A question regarding chloraprep- I see that many of you are using chloraprep for IV starts and line changes. Is it not true that chlorpaprep is not to be used in children under 2 months of age due to lack of research?

[dawngloves, BSN, RN]

yes every time we give an iv med or even flush an iv we use sterile gloves

Trying to wrap my brain around the rationale for this since it is a closed system and is not "open" unless the tip of a sterile syringe is introduced into the swabbed port.

[babiesRmylife]

it is a closed system but you are introuducing something into that closed system so it should be a sterile to keep from introducing any type of bacteria into the line. I believe its just to be extra cautious in doing that.

[NeoNurseTX, RN]

We use a lower percentage of CHG in skin prep and wipe it off w/ saline wipes.