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mcmiller
Standard for cleaning the junction between line and needleless connector when changing connectors on CVC

Does anyone have a written and possibly illustrated Standard that addresses how we should be cleaning the junction between the CVC and the needleless connector when we are changing the connector?  Should we be cleansing the port with alcohol? how does we avoid contaminating the pathway? is there a particular technique you are teaching? I do not see this issue addressed specifically. Maybe I am missing something?

lynncrni
No, you are not missing

No, you are not missing anything as this has not been addressed that I know of. There are hospitals that have developed their practices on this though because the contamination of the internal catheter hub was known to be a risk factor about 20 years ago. There is one in vitro study of cleaning catheter hubs with a variety of solutions. They even tested the effluent solution for alcohol concentration and found that it was so very low that it would not be of concern in their neonatal patients. Here is those references:

1.    Salzman MB, Isenberg HD, Rubin LG. Use of disinfectants to reduce microbial contamination of hubs of vascular catheters. J Clin Microbiol. Mar 1993;31(3):475-479.
2.    Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG. A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis. Feb 1993;167(2):487-490.
3.    Salzman MB, Rubin LG. Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition. Apr 1997;13(4 Suppl):15S-17S.

Then there is the new product called SiteScrub, soon to be available. It is designed to clean both the connection surfaces of the needleless connector and the internal lumen of a catheter hub or stopcock. It contains 5% CHG and IPA.

Descriptions of cleaning technique is to use an alcohol pad wrapped around the catheter hub and move it in a rotating motion around the luer lock threads. The only way to prevent the solution from getting in the lumen would be to have an administration set with a retractable luer locking collar. This is unlocked and moved away while the slip luer tip resides in the catheter hub. Based on the Salzman work and this new product, I really don't think we should be concerned about what gets in the lumen. After all we are instilling alcohol now in some catheters as a treatment for CRBSI to salvage the catheter. It is also used as a routine lock solution for some patients. And their is the new lock solution recently introduced in Canada that contains 4% citrate and 30% ethanol. Not available in the US yet.

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

Tom Billings
cath hubs

I know at least one of the new disinfecting caps is designed to not only clean the outside of the hub but also has a spongelike material that goes into the catheter hub.

-Tom Billings, RN

not affiliated with any swab caps btw...

lynncrni
That would be the product

That would be the product called SiteScrub I mentioned, on exhibit at INS and AVA last year, never actually on the market, and now acquired by Bard Access. They should be marketing it shortly but I don't have any information about when. 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

mcmiller
Clean the catheter hub only if bloody or soiled or always?

One additional question.  Is is standard practice to clean the hub automatically before attaching a new needleless connector or only if it is bloody or soiled?

lynncrni
I would clean it with each

I would clean it with each change of a set or connector, even if there is no visible blood or soiling of any kind. Skin oils, drug precipitate and blood can be found on these hubs and may not be easily seen. 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

Tim
You can clean the hub with

You can clean the hub with minimal risk of foreign materiel entering the lumen by putting a luer slip syring into the hub before cleaning.

Tim

Tom Billings
 Be sure to let any solvent

 Be sure to let any solvent (alcohol) dry as they can soften the plastic and cause the connector to become stuck on the catheter. If using betadine, rinse with alcohol as povidone iodine can be very tacky.

-Tom Billings RN

Product Specialist for ICU Medical, Inc

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