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Your NICU's protocol for cleansing IV ports

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We are having a large number of nosocomial sepsis in our unit and I have volunteered myself for the research and protocol write. :eek: 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

Specializes in L/D 4 yrs & Level 3 NICU 15 yrs. Has 19 years experience.

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

Specializes in NICU, PICU, educator.

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.

babiesRmylife

Specializes in NICU level III. Has 9 years experience.

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

Specializes in NICU. Has 1 years experience.

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.

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

Specializes in NICU level III. Has 9 years experience.

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

nurse2teach

Specializes in ob/maternity/nbn. Has 12 years experience.

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?

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

Specializes in NICU level III. Has 9 years experience.

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

Specializes in NICU Level III.

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

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

We use on kids over a kg...and sali-wipes after to prevent burns.

nicurn-jenn

Specializes in NICU. Has 5 years experience.

When giving any iv meds we wipe with alcohol swab for 15sec and let dry, pretty standard across most hospitals. We access all med ports with sterile gloves. We change TPN/IL and tubing every 24 hours including med line if there is one. changing this tubing requires a sterile field and sterile gloves. Sterile gloves must also be used to connect it to the baby. For ALL line insertions we use a 2% CHG solution that is wiped off with a saline wipe to prevent burns. (which will happen, i'm on our skin care team and when this happens, although infrequent, its sad.) Every baby has their own bottle of the solution at the bedside and a brand new bottle is used with any sterile procedure being performed. Of course a sterile field with all central line insertions and dressing changes, also everyone in the room during a dressing change or central line placement must wear a hat and mask. All this is a pain, some of these protocols are newer, but our infection rates are low. So i guess its worth it in the end.

littleneoRN

Specializes in NICU. Has 6 years experience.

I don't understand the sterile gloves for IV meds either. You are cleansing the port, which has not and will not be sterile. You shouldn't be touching the end of the port with your gloved hands, sterile or not. You should only be introducing a syringe which came from a sterile package and has since been capped. And you shouldn't have been touching the end of that either. I guess I just don't see the benefit there. Although we always have ways we can improve, I know that according to the VON data, our unit has a very low infection rate compared to expected for acuity. We definitely don't use sterile gloves. In fact, we string our own TPN non-sterile (just clean gloves and a clean surface, except for our highest risk patients, whose TPN is strung under laminar flow. We are sterile for line placements and dressing changes. We cleanse with chlorhexidine for both ports and skin prep on all babies except micros. Micros get betadine due to their skin fragility and increased absorption of chemicals through the skin. 30 seconds scrub, 30 seconds to dry.

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

Many places add the total sterile gloves, etc when they are still having issues with infection. 99% of the time, line sepsis is caused by accessing the line for meds, draws, etc.

We are fanatical about cleaning ports...also remember to wipe your ports after you are done accessing also..esp if you are drawing bloods, bugs love blood!

EmilyPeruana

Specializes in NICU. Has 3 years experience.

oh we have a whole algorithm....

but generally speaking, we use CHG b/f using a port...scrub 6x 360*...wait about 20sec for it to try...time sucks but it works b/c we've broken our own BSI records...

in terms of line changes, we do 2-person line changes q3d...we have one person be the sterile person...one be the clean person to hand everything to the sterile person or hook up things to flush...has worked ok for us so far...