Prehospital Access of Central Lines

Akulahawk said:
Technically speaking, we are supposed to scrub the hub of the PIV, for the same reason we scrub hub of a PICC or CL. Now then, all that being said, the PIV just isn't left in all that long so the chance of getting an infection from the PIV is much lower. Central Lines, Mid-lines, and PICC lines are typically left in much longer so greater precautions need to be taken to prevent the line from becoming the source of an infection.

I wish we had Curos caps. They're great! One hospital I was in during my final semester in nursing school required their use on all ports of any line that is connected to a patient. Apparently they had a very low rate of IV line-associated infections simply because of this practice. Probably all due to the fact that few nurses were actually scrubbing the hub...

Yes, we do have biopatches but we only use them for central line dressing changes.
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I was just joking around about scrubbing the hub of the PIV (don't think it came across well via text!). The likelihood of serious complications from a PIV is pretty small, but better safe than sorry. I will admit, however, that just like you I'm more careful with central lines.

I wish we had the Curos caps in the ER, but unfortunately we don't (for that rare port access or CIV insertion). In the unit, though, we have them and I use them all the time, and love them. They're a great addition in the fight against CLABSIs, but the ports still need scrubbing even when they're on. I don't use them on my PIVs, and I think I can count on one hand the number of peripheral IV infections I've seen. I'd be curious to see if they actually make a difference on PIVs, but that might be a hard study to do considering how short the life span of a PIV is.
 
medichopeful said:
I was just joking around about scrubbing the hub of the PIV (don't think it came across well via text!). The likelihood of serious complications from a PIV is pretty small, but better safe than sorry. I will admit, however, that just like you I'm more careful with central lines.

I wish we had the Curos caps in the ER, but unfortunately we don't (for that rare port access or CIV insertion). In the unit, though, we have them and I use them all the time, and love them. They're a great addition in the fight against CLABSIs, but the ports still need scrubbing even when they're on. I don't use them on my PIVs, and I think I can count on one hand the number of peripheral IV infections I've seen. I'd be curious to see if they actually make a difference on PIVs, but that might be a hard study to do considering how short the life span of a PIV is.
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I might tend to agree with you on this. I've only seen a couple instances of phlebitis from a PIV, and no infections so far, at least in the ED precisely because the vast majority of our PIV lines are pulled within hours. I originally was taught that a PIV can only stay in place for a max of 3 days, but lately the prevailing thought is to rotate the PIV site only when there's evidence of a need to. For patients that are long-term inpatients, that can save them a ton of (probably) unnecessary pokes. The other thing that we were taught was to pull Field PIV lines within 24 hours due to "high risk of infection." I was taught to start lines in the field in basically the exact same way I was taught to start them in nursing school. Properly done, there's no difference in risk. A couple years or so ago, I delved a little more deeply into it and it seems there were 2 things going: one was the fear that the paramedics were't doing things "the right way" so those sticks were "dirty" and the other (more likely) was that the hospital has little to no clinical oversight of field personnel so if a problem did develop with an IV, they can't directly go back and retrain the "offender" and therefore cannot unequivocably state that the PIV was emplaced to their standards. Same reasoning behind why lines placed at one hospital (PIV and central) may be changed very soon after arrival at a new facility. Basically they're changed out for legal defense reasons rather than clinical reasons.
 
I'd say the same number of nurses are scrubbing central line ports for thirty seconds with chlorhexadine as are taking 2 minutes to push Protonix.
 
Brandon O said:
I'd say the same number of nurses are scrubbing central line ports for thirty seconds with chlorhexadine
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30 seconds?

10-15 seconds with alcohol is fine. I just do 15 solid twisting scrubs with the prep pad.
 
Summit said:
30 seconds?

10-15 seconds with alcohol is fine. I just do 15 solid twisting scrubs with the prep pad.
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I think it's 30 for chlorhexadine.
 
Brandon O said:
I'd say the same number of nurses are scrubbing central line ports for thirty seconds with chlorhexadine as are taking 2 minutes to push Protonix.
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I actually take the time to push Protonix...
 
VentMonkey said:
Is this truly a reason it's typically infused?
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Heh, no, just commenting on how typical practice often doesn't quite match what the textbooks suggest.
 
NPO said:
Do your protocols allow you to access central lines? If so, what do they say? Only in cardiac arrest, or when ever you deem necessary? Do they go into detail? Likewise, if not, do they say why and do they provide an alternative?

I recently brought up the subject of accessing central lines to my medical director because our protocols don't mention it.

He acknowledged that our protocols don't mention it, but encountered their use when justified in an emergency. He even went so far as to say that if a dialysis access line is all we have in a true emergency, then do what you have to do, but understand that the nephrologists will hate you for it.

I'd like to hear the input of others, and what you practice in regards to central lines.

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Accessing CVPs is not a big deal. It is overhyped. Depending on the line, there are usually 1-3 ports. The blue port is usually the one that "we" nurses are allowed to access. The biggest point is to "scrub the hub" as central-line associated blood stream infections (CLABSI) is the main concern. Except for IVADs (Portacaths), you only have to flush with normal saline and not heparin. IVADs are implanted under the skin and you must use sterile technique to access them and flush with heparin afterwards. And access is with a Huber needle (special type) as previously mentioned. We waste 5cc of blood initially, not 10.
 
Yes, we can access central lines.

"Indications for invasive line access: Cardiac arrest, hemodynamic instability, or currently accessed". So you're sick for a day with nausea? Not going to access your central line for Zofran. Septic with hypotension? Sure.
 
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