I am reviewing our policy and procedure around cleansing the skin prior to removal of a catheter that is going to be sent for tip culture. We are using the Manual of IV Therapeutics, Lynn D. Phillips 5th edition as our reference manual. It states that 70% alcohol should be used for skin cleansing due to the residual antimicrobial effects of iodine containing solutions. It does not address CHG as a skin cleanser or its residual effects. My thoughts are that if proper drying times (3 mins) are adhere to, CHG would be a more appropriate choice, but I'm having trouble supporting that with EBP. Your thoughts and input would be apprciated.
Donna Pagel RN, CRNI
St Charles Medical Center-Bend OR
I don't know that you will find evidence for or against use of CHG for this purpose. Use of alcohol comes from a procedure published a long time ago in the book, Hospital Infections, and the chapter on Intravenous Therapy written by Dennis Maki, MD. I am not sure what year the 5th edition of Lynne's book was publshed, but she was probably referring to Maki's work. I am wondering why the tip culture is being done - routine practice for all CVADs, diagnosis of BSI, or other? CHG has much better residual effects than povidone iodine, so it would seem that alcohol would still be the recommended agent. Regardless of the agent, the operator would still need to be extremely careful to prevent the catheter tip from touching anything, especially the skin, during removal. 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