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Wendy Erickson RN
Scrubbing the Needleless Connector

INS Standards state that needleless connectors should be scrubbed prior to each access.  In using the SASH method for example, the (simplified) steps would be:

Scrub - Saline - Scrub - Antibiotic - Scrub - Saline - Scrub - Heparin

In developing a system-wide policy for PICCs and CVC's, I am running into resistance.  With the support of Infection Prevention and Control (!!!), the policy reads:

Scrub - Saline - Antibiotic - Saline- Heparin   One scrub at the beginning only as this sequence is considered "one access".

 

I am continuing to press this issue and have been asked to find out what other hospitals do.  My question is:  do your nursing policies SPECIFICALLY state "scrub before each and every access"?  If so, could you provide me with a copy of your policy?  Y0u can email me your policy if you prefer to [email protected]

Thanks!

lynncrni
 I don't have a policy to

 I don't have a policy to share but wanted to add one more fact to add to your efforts. I am working on the new Needleless Connector standard at this very moment and the same emphasis on scrubbing before each entry will be included. It is important to remember that all studies establishing a time for scrubbing are in vitro studies. They either culture the effluent as it is flushed through a contaminated connector or directly culture the connection surface. None of these studies have looked at multiple entries into the system in a clinical setting. Clinical data comes from studies assessing outcomes with disinfection caps but even those studies did not explore this question. The standards committee in 2011 thought this was important enough to emphasize scrubbing with each entry due to easy contamination with each SASH connection. Lynn

PS, this should apply to PIV and midlines as well as CVADs

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Liz Donnellan
I have a similar question.

I have a similar question. Even if a alcohol impregnated cap is being used, scrubbing before each entry should still occur in an intermittent situation (blood sampling, SAS-H etc.), per INS 2011 correct?

I don't think the cap companies are teaching this standard.

lynncrni
 You are correct that the

 You are correct that the connection surface should be disinfected before each subsequent entry when a disinfectant cap has been added to render the first connection as disinfected. No studies have addressed the length of time for this scrubbing between entries, with or without the disinfection caps. I know that the official company position for Curos and Swabcap is that this manual disinfection should be done between subsequent entries. However, many sales reps are saying what they want to say and not giving a clear description  of this process. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Chris Cavanaugh
This amazes me!

I have run into the same sillyness at a few hospitals now.  I don't get it.  One was a hospital with mostly "new" nurses of less than 5 years experience, they used an alcohol cap, and could not understand why to swab inbetween.  OK, I get that, they only know what the reps told them, but if you were around before alcohol caps, what did you do then???

It's not just INS that says SWAB with EACH access, it is also the SHEA Guidelines, CDC, FDA and JC.  They also say to use FRICTION, which you cannot do with an alcohol cap, it simply bathes the connector with alcohol.  No FRICTION.  

 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Liz Donnellan
 Thanks Lynn and Chris!

 Thanks Lynn and Chris!

Wendy Erickson RN
Thanks for all the support. 

Thanks for all the support.  Detractors tell me that they keep the needleless connector sterile in between syringes and therefore do not need to swab again.  But how many times haven't we all missed the cap and hit our gloved or non-gloved finger with the syringe tip, or dropped the line onto the bed, then picked it up again, or scrubbed with a little alcohol wipe and realized that you're scrubbing with your bare finger as well as the wipe?!  We've all been there, and we know better! Thanks again!

Wendy Erickson RN
Eau Claire WI

lynncrni
 Also left blood-tinged fluid

 Also left blood-tinged fluid when the flush syringe is disconnected or lint and body oils from being connected for 30-60 minutes and in the patient's bed. Lots of room for all of these practice concerns and probably more than we have not thought of. Lynn

 

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wendy Erickson RN
Another question/thought:  no

Another question/thought:  no one seems to have a policy that specifically states "each and every time".  How do you know your nurses are doing this?  Do you audit this or have "secret shopper" type observers?

Wendy Erickson RN
Eau Claire WI

lynncrni
 I have never seen a good

 I have never seen a good method from monnitoring compliance on this issue but I like your secret shopper idea! Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

valoriedunn
This is copied and pasted

This is copied and pasted from my P&P. I need to "tweak" it a little more though.

7.Scrub needleless connector with alcohol pad for at least 15 seconds.
8.Unclamp catheter.
9.Attach the pre-filled 0.9% sodium chloride syringe to the needleless connector.
10.Inject 0.9% sodium chloride and remove the syringe.
11.Clean the needleless connector with a new alcohol pad for at least 15 seconds.
12.Attach the pre-filled heparin syringes to the needleless connector if indicated. It is recommended that a new alcohol wipe is used for each manipulation of the needleless connector or hub scrub.
13.Inject heparin and remove the syringe from needleless connector..

Valorie

Valorie Dunn,BSN, RN, CRNI, PLNC

lynncrni
 This does not include

 This does not include assessing catheter function by aspirating for a blood return or checking for resistance. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wendy Erickson RN
Thanks, Valorie!

Thanks, Valorie!

Wendy Erickson RN
Eau Claire WI

BJ Emory
Scrubbing the needleless connector

We are using port protectors and our policy states:

  • Vigorously scrub the hub for 15-30 seconds with alcohol wipe and let dry:


    • When there is visible soil on the port

    • Between sequential accesses (before saline flush, before medication administration, before saline flush)

    • Scrub the hub if you remove the port protector and leave the access port exposed for any period of time before accessing

BJ Emory, RN, CRNI

Infusion Education Co

Wendy Erickson RN
Thanks, BJ!

Thanks, BJ!

Wendy Erickson RN
Eau Claire WI

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