What is the best way to cleanse the cap on a picc line?  In the old days we used three alcohol and three betadyne wipes.   Then we went to chlorhexidine swabs.  Now I see at other facilities they are using one alcohol swab to access a picc.   Now I see also the Swab Caps.   We are going to those.  

That was MY first argumemt!!!

That was MY first argumemt!!!

 How are these protective

 How are these protective caps being paid for? If this is an HMO, they are working from a capitated fee. So look at costs. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Swab caps

Hi Lynn,  I am going to battle with my facility as when I teach a Home IV patient the pharmacy won't provide any alcohol pads for use in their supplies, only Swab caps.   I explained that the Swab cap is good at the end of the SASH procedure but it is necessary to use a 15 second alcohol wipe scrub in between the SAS or SASH procedure.   Like you said, before each and every entry into a line.  I work for a large HMO and it is very difficult to get policies changed and I believe very strongly about this.   I brought up the senario that the pt could drop or contaminate the IV line cap in between the SAS procedure and would then at least need to cleanse with an alcohol wipe.   I was told the pt should put on another Swab cap and wait 5-10 minutes before resuming the procedure.   I think this is rediculous as I have seen peripheral IV lines clot in as much time!   Any sugesstions?   I feel alone in this at work. 

Thankyou very much Lynn,  I

Thankyou very much Lynn,  I really appreciate your help and time.

 Your reference is the

 Your reference is the Infusion Nursing Standards of Practice. If you do not have this, it can be purchased at www.ins1.org and is a much needed documented for anyone writing p&p. 

Clamping is necessary anytime the line is opened to prevent air from entering the line. If changing syringes between SASH, clamping is not necessary as the needleless connector prevents the line from being opened. However at the end of the final locking solution, you should leave the line clamped as a safety measure, just in case the luer connection on the needleless connector comes loose. The flushing-clamping sequence depends upon the type of NC being used - negative is flushing, clamped, then syringe disconnected; positive is flushed, syringe disconnected, then clamped; neutral can be in any sequence. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Disinfecting central line caps/procedure for accessing ports

Thank you for this information on disinfecting central line caps.  I am in the process of updating the procedure for accessing/deaccessing implanted venous ports for our hospice.  As always, the devil is in the details.  Would appreciate your help with these questions:

1.  Now that I've read this, I'll include cleaning the cap prior to each access.  Would you please give me the reference for this to include in my policy and procedure? 

2.  Should you clamp the extension tubing on the Huber needle everytime the end of the extension tubing is open... that is, before removing the cap and before each syringe is changed during SASH, medication administration or blood drawing?

Thank you!

Celeste O. Phillips, MN, RN-BC Hosparus, Inc Louisville KY

 First, you must address the

 First, you must address the disinfection of all needleless connectors on all types of VADs, and not just PICCs. There should be no difference based on the type of VAD in use. The only evidence right now is based on in vitro studies. Those studies show that scrubbing with an alcohol pad for 15 seconds will remove the majority of organisms. Cleaning for any period less than 15 seconds will not result in removal of these organisms. Please take note that this data is from lab studies only and there has not been any clinical studies correlating a reduced rate of CRBSI with any method of cleaning needleless connectors. 

There is one study in progress that I know of, however I am sure there are others. The study I am referring to has been presented as a poster at several conferences such as SHEA and APIC. This study is comparing 15 second scrubbing with an alcohol pad to the use of disinfectant caps - the protective caps that contains an alcohol soaked sponge. Phase 1 of this study used the manual scrubbing with 1 alcohol pad. Phase 2 used the disinfectant caps between VAD uses, and Phase 3 was return to the manual scrubbing. Blood was taken for the PICC each morning and cultured. The data from Phase 1 & 2 are available showing fewer numbers and types of organisms during the phase using the disinfectant caps. These caps do not mean that scrubbing is eliminated. Each connection to the needleless connection requires scrubbing. SASH means 4 alcohol pads and 4 scrubs. If using the disinfectant cap, you can eliminate the first scrub only, then scrub again with each subsequent connection of the medication, second saline, and heparin if used. 

Alcohol is the "gold" standard for killing organisms and is sufficient for this scrubbing. One alcohol pad for each entry. Until we have ore studies, this is what should be done. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861