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Donna Fritz
port access--clean vs sterile reference

This issue comes up periodically.  I have found the study that I refer to for comparing the two techniques for port access in an outpt setting.  The reference is:

 Long, C. and Ovaska, M.  (1992).  Comparative study of nursing protocols for venous access ports.  Cancer Nursing, 15(1), 18-21.


 "The purpose of this study was to compare the incidence of infection in patients having venous access ports (VAP) accesed using commercially prepared kits with patients having VAPs accessed using a nursing protocol developed by RNs in the outpatient chemotherapy unit.  The RN-developed protocol allowed venous access devices to be approached without sterile gloves and with minimal equipment, a technique which is more time efficient and cost effective.  A convenience sample of 26 outpatients was randomly assigned to two groups.  Patients in Group I, accessed using the commercially prepared kits, were accessed a total of 69 times.  Patients in Group II, accessed using the nursing protocol, were accessed a total of 102 times.  The two groups were compared for occurrence of infection as identified by elevated white blood cell  count (WBC); febrile episode (>100.4 degrees F); or drainage, pain, redness, swelling, or warmth at the port site.  Data collected over a period of 6 months indicated no documented infection in either group.  Results from this study will be used to support changes in nursing practice."

This study cites in the lit review an article by Lisa Schulmeister from 1987:  "Schulmeister compared a sterile-gloved procedure with a clean, nongloved procedure for accessing ports in 40 patients over a 1-year period.  The ports were used in both in-patient and out-patient settings for chemotherapy, fluid administration, and drawing of blood samples.  No febrile episodes or septicemia occurred in either group in the study.  This study found that the clean, nongloved technique was more time efficient and cost effective.  Further replication was recommended." p. 19

The citation for the Schulmeister study is from 1987, A comparison of skin preparation procedures for accessing implanted ports, NITA, 10:45-47.   I have not reviewed this study, but would appreciate a copy if anyone has it.  Maybe you can post it.

 Both studies are fairly old.  Long and Ovaska used 3 alcohol swabsticks followed by 3 povidone-iodine swabsticks as the skin prep.  In group I the only differences seem to be that syringes were filled with saline and the needle set primed in a sterile manner and the access was done with sterile gloves.  In group II, priming was done with bare hands holding the syringe and clean gloves put on to handle the needle set and access the port.

 I would be concerned about generalizing the Long and Ovaska study to inpatients.  It is never overtly stated in the article, but one would assume that these accesses were "in and out" the same visit.  This is in contrast to inpts, who might have their port accessed with the same needle for 7 days.