I need some feedback on using an alcohol swab around PICC insertion site before using the CHG wand. Is this necessary? I have always understood site care with an approved skin aniceptic as being either, CHG, 1% or 2% tincture of iodine, iodophor, and 70% alcohol (with CHG as the prefered). I have never had our home care and hospice nurses use the alcohol swab stick prior to the CHG and we have not had any CLABSIs in the 5 1/2 years I have been infusion coordinator. Our hospital education department is teching the bedside nurses to do both.
Thanks, Valorie Dunn, BSN, CRNI
Both CDC and INS emphasize applying the skin antiseptic to CLEAN skin. Before a PIV or CVC insertion, you can wash the skin with soap and water. This is not possible when you have an insertion site already present. If the skin is visibly dirty with dried blood, sweat, or skin oils, I think it would be important to remove this before applying the antiseptic, but the question is how. In my opinion, this would be done with an alcohol pad or sterile water or saline. Looks like the alcohol pad would be the easiest to obtain. All CHG products used for this purpose in the USA contain alcohol. So you could say that this is sufficient, but I think it is more effective when applied to clean skin. So if the skin is dirty, I would use an alcohol pad to remove that dirt before applying the CHG. Lynn
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
I should have been more specific Lynn. I do use alcohol preps to clean dried blood before using the CHG however, I do not use the swabs/preps when there is nothing visible because the Chloraprep has 70% isopropol alcohol in them.
Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
If the site is not visibly dirty, there is no evidence that it requires a 2-step procedure with alcohol first followed by CHG. Might be better for all CVCs but I am not aware of any evidence to support it. Lynn
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
According to the IFU for chlorhexidine swabs, it is not intended to be used on "open wounds". Our infection prevention team considers the puncture/insertion site to be such, so we also clean the immediate insertion site (which will then be covered by the biopatch) with alcohol and the rest that will be covered by the dressing with CHG.
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
I am not understanding the logic of the infection control team. They don't want to use CHG on the puncture site in the form of a swab but are ok in the form of a CHG impregnated sponge?
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Great point Stephen, thanks. :)
not sure what point of alcohol swab is? Since CHG is mixed in alcohol. the only thing I can think is they are using the alcohol to wipe off the CHG to reduce irritation to the insertion site? Redness?
Removing the CHG removes any residual function of the CHG and now you have a good disinfectant (alcohol) but it has no residual kill.
kathy kokotis
It is the same concept as putting dishes loaded with food particles into the dishwasher with first doing a preliminary scraping. The alcohol swab would be used to remove any dried blood, excess skin oils, tape residue first and this would be the cleaning step. This would be followed by the CHG application for the antiseptic step. No antiseptic agent will be at its most effective in the presence of all those other materials that could be on the skin. That is the time when I think we still need to use alcohol alone in a 2 step process. Lynn
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