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Nan Morris
Disinfectant caps for peripheral lines

Our facility is in the process of getting disinfectant caps. I was looking at doing this primarily for central lines, but the rep said that including peripheral lines was important for compliance and for reducing blood stream infections.  He stated that this was presented in the SHEA recommedations published in  Infection Control and Hospital Epidemiology in 2014; I had interpreted this as a preventative measure for CLABSI - the statement was under the heading "Special approaches for prenting CLABSI" (p. 757). 

My questions are: Is there sufficient evidence for the use of these on peripheral lines?  The cost of a cap is +/- $.20, the cost of an alcohol wipe is, I believe, about $.04. Do people use them soley on central lines, or do they use them on all IV access devices?  Thanks, Nan Morris, RN

lynncrni
 The SHEA document is about

 The SHEA document is about CLABSI, which is central lines only. But your organization will not receive payment for any type of infection through any type of catheter. Payment for hospital acquired conditions is not limited to central line nor to only BSI. Rates for infections in PIVs are now well known but we know that it does occur. So why would you not use the same processes for preventing BSI in both types of catheters? You can enter an interstate highway from a mulitple lane entrance ramp in the heart of a city or from a single lane ramp out in the rural area but you can end up in the same place. Same thing with anything going into the bloodstream. A PIV can lead to BSI so I believe disinfection caps are required for all VADs. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Nan Morris
re: disinfectant caps

Thank you, this is the path we're taking. 

Vickie
We implemented the

We implemented the disinfectant caps for all central lines and PIVs are optional.  From experience, I would recommend implementing them for all lines.  There will be a lot less confusion about which lines to put them on and it will be much easier to drive compliance.  Good luck with you implementaton, they are a great product and really help reduce infection. 

Vickie Teresinski, RN, CRNI

jill nolte
.....and then there is this

 I keep finding Swab Caps used as dead ends or tip caps, no needle less connector present.  And I believe it was Keith Gilchrist who pointed out there is the assumption the previous nurse used a new cap on the line.  The education component is ongoing.

kejeemdnd
Do these caps make anyone

Do these caps make anyone else uneasy?? I like the idea in theory, but I am skeptical about any device that assumes the previous nurse/caretaker used it properly. I must admit that I like seeing a needleless connector with a disinfectant cap on it whenever I take over care, but I will ALWAYS swab that connector with a fresh alcohol swab prior to accessing it because I can't know for certain that this cap is fresh. How many times have you opened an alcohol swab and it was dry? What if the cap is defective in a similar way? What if the cap fell off and the well-meaning patient picked it up and put it back on? What if an uneducated caretaker thought the cap was good for 72 hours and could be reused? The cap seems like a good device when used exactly in accordance with the conditions from which the publish data was derived. Indeed, Jill, the education component is ongoing!

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

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