I work in pediatrics and we have a growing (and challenging) population of mastocytosis or mast cell disease patients. We have managed their alcohol allergies, present in the majority of patients, by using betadine and sterile NS for skin antisepsis for PICC dressing changes. For all of these patients we have been able to use alcohol wipes to disinfect their needleless ports.
We now have a patient that both she and her mom (primarily her mom) have severe anaphylaxis with alcohol. I have reviewed both INS and CDC guidelines. It is suggested to use betadine as an alternative to CHG for skin antisepsis.
My questions: 1) is betadine considered as an appropriate alternative antiseptic to clean needleless ports? 2) If so, how long should it remain in contact with the needleless device? 3) remove the betadine with NS sterile wipe? I am concerned about the patient potentially getting betadine potentially flushed through her PICC in a less than perfect world.
Another consideration: 1) mom draws up sterile water, 2) rinses the needleless cap, 3) dries it with a sterile 2x2. Very complex with a double lumen PICC needing accessed potentially several times/ day.
I am interested if any of you can offer other solutions? Most of our home vendors do not carry sterile NS wipes, so this may be an out of pocket expesne to the already strained family.
Thank you in advance for any recommendations offered. In addition, if you have any literature to support recommended interventions, this is most appreciated. I am a frequent flyer of learning so much from the listServ and am grateful to be able to reach a wide range of VAD experts to help solve this problem.
Linda Tirabassi RN CNS CPNP
Miller Children's Hospital
Long Beach CA
Wow what a challenge! Are you sure this is a true IgE mediated allergy or a chemical stimulation of the mast cells? Either way the clinical S&S are the same. Is the problem caused by physical contact with the alcohol, breathing the alcohol fumes or both? You could try the disinfecting caps with alcohol as there would be no contact between pateint, caregiver, and the alcohol. They would protect the connector surface and disinfect also.
Povidone iodine (Betadine) is a very weak disinfectant. Plus it can leave a tacky residue that may make it very difficult to remove the attached IV set. I would not be worried about flushing either povidone iodine or alcohol through the catheter lumen. There is a study from the 1990's showing this was not an issue.
The physical scrub with sterile water or saline before connection along with protection between uses may be sufficient. There are no clinical studies on these issues, only in vitro lab studies. The clinical studies have used the disinfection caps with good outcomes reported. The other option is to use the Site Scrub product, also impregnated with alcohol in a scrubbing cap and would prevent skin contact with the alcohol, no clinical studies on outcomes with this device, and it does not remain on the connector to protect it between uses.
The other option would be aqueous CHG, bought in bottles at a local drugstore. it could be used with a gauze to clean These are 4% solutions without alcohol.
Hope some of this works. 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
Thanks Lynn for your comments and recommendations. I will give you a little more detail onthe situation: The mother stated she thought she may be sensitvie to alcohol. I had her wear a mask, gloves, and open the alcohol in a baggie to let the vapors dissipate, she cleaned the needleless connector and then require Epi. Given that, I chose not to consider any port protector at this time. I had investigated site scrub for a past patient but was unsuccessful to obtain them for home care. For this mother it is the olfactory trigger that is most severe, unlike many of the prior kids I have worked with who had both skin triggers and olfactory, but skin was more dominant. Yes challenges never cease.
The CHG 4% may be the best bet. Do you think, given the residual, after cleansing with it, squirt if off with some NS and then dry with a 2x2 would be safer? I hate to think of the resudrual attracting organisms.
I would be interested to learn if others have experienced any such challenges.
Thank you again.
Linda T.
Linda Tirabassi PhD RN CNS CPNP