My hospital wants to implement appying alcohol caps to all PIVs and central lines. We have trialed alcohol caps for a year and, the depts that we used these caps have had better CLABSI rates. The value analysis nurse at my hospital is wondering whether we need to use these caps to ED patients or not. If any hospitals are using this cap, would you like to share information whether you use it to all patient vs. inpatient only? Thank you so mcuh for your information in advance!
I can almost understand the thinking on this, but not quite. How many ER patients get discharged and how many get admitted? I would bet almost all have some type of VAD inserted. I would bet the thought is that the discharged ones don't need this cap as they will not be here when a site becomes infected, so why should we do this one step to prevent it from contamination? I have had several legal cases of PIV associated infections with almost all being started in the ER. Several studies implicate the rates of BSI from VADs begin in the ER. You probably don't have the ability to determine whose line will be removed in a few hours and whose will remain in place as they are admitted, so to be on the safe side I would say the same standard of care should be applied to all patients.
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 for your input!
Jonghee
Vascular Access Team
Highland Hospital
Rochester, NY
We are using the caps and we apply to all in-patients, all patients that will be admitted AND all patients that may be discharged with an access device. These are the reasons we carry them in the ED, PACU, and soon Outpatient surgery center and infusion center. The downfall of placing on everyone is that most caps need at least 3 minutes to appropriately disinfect.
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
We have just implemented the caps on all of our central lines. We will consider the peripheral lines once we get the process in place for the central lines. We are placing them on inpatients only. Do you place them on blood tubing and TPN tubing also, since these lines should not be accessed while they are infusing? We are having a slow compliance curve and are hoping this will improve as we move along.
As you said, blood and PN administration sets should not be used to administer any medication or inject anything through that line. I would use sets for those therapies that have very few injection sites, if that is possible. I would require them on all injection ports on any IV set used for any purpose as a means to standardize your methods throughout the entire hospital. Standardization should improve compliance. When one type of line or catheter requires these caps and others do not, that can only cause confusion and lack of compliance. A peripheral catheter can just as easily become contaminated as a CVAD. I just read a new study yesterday about stopcock contamination on peripheral catheter lines used by anesthesia and this caused a change in practice to require these disinfection caps on all lines. 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
Thank you for the input. We were coming to the same consensus so that we could have consistency in practice.
Here are some things to consider about "alcohol caps"
1) Cost--when they are placed on every injection site, Y site and end of every lumen the cost adds up--0.25 x ??? For a typical patient with a dual lumen PICC, you could use 4-5 depending on the tubing. That's $1.25. Then you access the line twice during the day to hang an intermittant IV, and once to draw blood, thats 3 more. The cost can be as high at $2.00 per day, times 10 day average dwell time, $20.00 or more for one patient.
They need to be replaced after every time the line is accessed, they cannot be reused, even if you only removed it for a "few seconds".
If you hang a strip of them on a patients IV pole, it will need to be thrown away when the patient is discharged. It cannot be used on another patient. How many are being thrown away 4? 6? x 0.25
2) They only replace the INITAL Alcohol wipe when accessing a catheter. AFTER the NS Flush, you still need to Scrub the hub before connecting the medication or drawing blood, and AGAIN when you disconnect and flush with NS and AGAIN if you flush with Heparin. THEN you place a new alcohol cap on the connector.
3) They ONLY address the top of the septum of a connector. There is one brand that is used, scubbed with and then discarded, that type addresses the threads on the sides of the connector. The ones that are left in place only touch the top of the septum. The threads of the connector on the sides are not touched by alcohol.
There may be more cost effective ways to prevent CRBSI.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC