Hello: for ultrasound guided PIV probe covers we clean the probes with the green bucket wipes for disinfection. What is the industry standard regarding probe covers? Is it good enough to clean in between patients with the recommended wet times per the wipes or should the probes be cleaned + use of probe covers?
INS Standards call for sterile probe cover and sterile gel for USGPIV. 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
Hello Lynn:
I am looking at the INS standards S45 and for UG PIV sterile probe covers it has the lowest rating of evidence V.
Do you know of any other evidence INS is basing the use of sterile probe covers on for UG PIVs?
We did some searching and sterile probe covers are $5 each. There are more options for non-sterile covers.
See page 6 on link below:
http://www.aium.org/resources/guidelines/usgva.pdf
We will budget for the $24,000 a year if the evidence is there that a sterile cover is required, but it may be half the amount for a non-sterile probe cover (still waiting for that price). We want to do what is right but INS conflicts with AIUM in regard to peripheral access.
Mary Lynn Rae, RN, MSN, CPHON
Clinical Nurse Educator
Ann & Robert H. Lurie Children's Hospital of Chicago
The Standards Committee from INS felt strongly that sterile technique is required for PIV insertion especially with the standard of changing these catheters based on clinical indication and not by the clock or calendar. The studies referenced are descriptive studies using sterile technique for insertion of USGPIV, which gives this the Level V evidence. To my knowledge there are no higher level studies comparing sterile vs non-sterile technique with USGPIV insertions but they may have been published in the second half of 2015 or 2016. However, the entire community of vascular access and infusion nurses do support use of sterile technique for this procedure, a frequent conversation at conferences. Some USGPIVs would be able to dwell equally as long as a midline catheter and those require sterile technique. The AIUM guidelines do support use of either a sterile probe cover or a sterile large TSM dressing over the probe for PIV insertion, which is the same as the INS standard. There is an inadequate amount of data collected on PIV infections BUT, we know that they occur and are going under the radar. I have recently reviewed lawsuits involving PIV-BSI leading to endocarditis. Infection in PIVs do happen but no one is collecting outcome data because they are not mandated to like they are with CVADs. I do not see the INS and AIUM in conflict with each other. And the AIUM is not considering the change in standards about removal based on clinical indication, referring to a PIV as a "short-term" device, not other detail on what that actually means. There are hospitals using sterile technique for USGPIV that are experiencing lengthy dwells of greater than 7 days although there data has not been published yet. I would certainly not recommend using a non-sterile probe cover for PIV insertion, but you can use a large TSM dressing. I firmly believe that sterile technique is required for this procedure. See Standard 33, page S65 where the standards recommends consideration of sterile technique for ALL PIV insertions. See front matter for how we used that word "consider".
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
Which cleaner to use on medical devices is stated in the instructions/directions for use by the manufacturer. Chemicals found in cleaners can degrade the materials used to make the device or cloud plastics. In this case it could cause the images to become blurred or crack the probe. Therefore, it is a very good idea to check the manufacturers guidelines on cleaning to make sure that the cleaner you are using is safe for the equipment while providing the antimicrobial benefits that are needed to keep patient's and clinicians safe.
It's been a couple of years now, but I had an ultrasound guided piv insertion kit made for less than $8 including a securement dressing. I am cheap though and used a wall glove to cover my probe to scout for a vein. It was against policy to place an uncovered probe on a patient. If you need a resource for a custom kit holler, I can help.
An article in "Infection Control Today" entitled Ultrasound Probes-A Call to Action from March 2017 explains how JCAHO is asking how the probes are being cleaned on their surveys, and hospitals are not faring well with their answers. Probes used for vascular access cannot be cleaned with the standard wipes used in hospitals. I recently contacted the company that provides our wipes and they confirmed this. You must use a high-level disinfectant(HLD), first ensuring that the probe can be safely cleaned with that material. I was told by the probe manufacturer that I could use the wipes, but they are not HLD so we are using an HLD provided to us by Environmental Services. Good luck!
just check with the probe manufacturer to ensure the HLD wipes won't damage the probe. That would be a disaster.