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Looking for central line cap changing protocol to prevent touch contamination

Looking for evidence based practice to support cleansing the PICC cap-catheter connection point with alcohol.  With dressing changes, we change the PICC caps.  If there is dried blood or chemical residue on the outer surface of the PICC lumen (not the cap hub), is it best practice to remove it with a sterile gauze or alcohol sponge? Thank you

There is no specific

There is no specific recommendation or standard for the length of time to clean the connection surface of a needleless connector prior to each use. There is one study demonstrating that IPA or CHG/IPA combo are both effective when used with friction for 15 seconds. There is also a study by Maki that 3 to 5 seconds with IPA is not adequate. FDA now requires that manufacturers show a 4 log reduction in lab studies when cleaning their needleless connectors. But no professional organization has made a statement about a specific technique or length of time for cleaning. SHEA compendium also says that either agent can be used, but no time. I would recommend changing needlelss connectors every 3-4 days. And I would also recommend that cleaning for all CVC female luer hubs be cleaned with the change of each tubing or connector. This is done with either agent. So there are 2 surfaces to be cleaned. The connection surface with each infusion and the catheter hub surface with each tubing/connector change. This protocol must also pay attention to accessing these connectors only with a sterile device. So the IV tubing must get some attention. It must be sterile for each use and use of longer than 24 hours is extremely questionable. We really do not even have data to support multiple connection and disconnections for 24 hours. CDC does not make a difference between continuous and intermittent sets but INS does. CDC does state clearly that a sterile device is required for each access though. So we must pay attention to both sides of this connection. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Lynn - would you recommend hearing the talk about the swab cap

at AVA?  I was unable to attend, and would like more information.  I'm not sure whether audiotapes or transcripts are available? 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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