Hi, I have been trying to find litterature on the best order to follow if patient is allergic to chlorhexidine and I want to use two antiseptic solution (povidine-iodine and Alcohol) but does not have access to a solution that has both in the same bottle.
Is there a prefered order?
In the INS book "Infusion nursing an evidenced based approach" on page 211, it states that for preparation of a peripheral IV site, it says to remove the tincture of iodine with alcohol because it may cause skin irritation.
On page 212, it says that Tincture of iodine and povidone-iodine, as single agents or in combination, used individually or in a sery may also be used but the following sentence says specifically that alcohol should not be applied after the application of povidone-iodine or tincture of iodine.
Both cite the INS, 2006.
Anybody has read something on this topic?
Thanks,
France
Any solution labeled as a tincture contain alcohol. So tincture of iodine is iodine in alcohol. Tincture of iodine should be removed because it can cause skin burns. With a dressing on top, the iodine is forced into the skin to cause this irritation. It usually heals sufficiently but must be treated until it does heal and not an injury you want near and IV site of any kind. Povidone iodine is a different combination and does not contain alcohol. There have been attempts at making combination products that do contain povidone-iodine and alcohol but those are no longer available. The overwhelming success of chlorhexidine gluconate is probably the cause of why those combo products are not available. Originally the thought was that povidione iodine should not be removed because there was persistent activity as long as there was the golden color. Given our advanced knowledge of iodine-based products now, we know that is not correct. The sentence about not removing the iodine with alcohol was removed from the 2011 INS Standards. This textbook came out before the 2011 standards, so the authors were using the 2006 standards. The bottom line for me is that I would not rely upon a povidone iodine solution when chlorhexidine is contraindicated. I would use alcohol in a sufficient number of swabs until they come away from the skin without any change in color. Skin oils and other debris can easily be seen on a white alcohol pad. Povidone iodine requires 2 full minutes to be effective and it should not be removed. It should be allowed to thoroughly dry without any fanning or blowing. It can't be rushed and I don't think most busy nurses would allow sufficient drying time and thus the effectiveness would not be as good. Textbooks and standards are always a work in progress as new information constantly becomes available, even on the old stuff. 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
Ok, so rather than 2 solutions, isopropyl alcohol is sufficient - given prep pad is clean after the application.
Thank you very much!
France
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
In my opinion it is, but I would take this question to your infection preventionist or hospital epidemiologist or infection committee. None of the guidelines or standards call for use of 2 agents for skin antisepsis. They do state that skin antiseptics should be applied to clean skin. So before insertion, you should do a soap and water wash. During dressing changes, obviously you can wash with soap and water. I would use alcohol to remove sweat, dried blood, then apply the CHG. If CHG cannot be used due to allergy, etc. your IP may still want you to use povidone iodine. But that is a decision that should be made by the experts in your facility based on your patient population, etc. 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