Hello;
I see that there have been posts made about this in previous years but I am still feeling like I need some clarity as to what is the best practice with regards to cleaning the CVC hub when changing a needleless connector. The CDC guidelines state "Scrub the injection cap and catheter hub with appropriate antiseptic agent; clamp the catheter if necessary as cap is removed. Attach new cap to catheter hub using aseptic technique".
This can be interpreted as direction to clean the connection to the needleless connector and CVC hub, then removing the cap and applying the new cap, if follow the order of what you are reading. The question is, do you clean just the connection, remove the old needleless connector and apply the new needless connector? Or do you clean the actual CVC hub that the needleless connector attaches to.
I personally do not feel right about putting a new sterile connector onto a hub that was not scrubbed but the opposing perspecdtive is that if that connection was not contaminated then scrubbing the actual CVC hub is not necessary. The INS standards do not specifically address this (that I can find) nor does the CDC, beyond the statement above. I have found several policies that do direct the nurse to remove the connector and scrub the CVC hub but I would like to see what evidence there is to support this so that I can ensure I am supporting the best practice.
Thanks so much in advance
Tammy
In the 1990's there were several published articles emphasizing the fact that the catheter hub is a significant source of organisms that contaminate the internal lumen of the catheter. About that same time, the use of needleless connectors was growing and the risk of infection associated with their use took precedence over the actual luer-locking hub. To my knowledge, there are no actual studies about the agent or technique that is best to clean the hub. I know of many hospitals that have a policy to clamp the catheter, removal all sets connected, wrap an alcohol pad around the luer locking threads and rotate several times. This allows removal of dried blood, dried drug precipitate or glucose, skin oils, etc. I believe this is a good idea, however I have never seen any evidence pro or con about this technique. This lack of evidence is what causes a lack of statements in standards and guidelines. 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
Thank you Lynn for this very helpful response. Although I cannot concretely use the wording in the INS standards or even the CDC guidelines to support this practice without differing perspectives, I am hearing from you and from my own colleagues, that it is a common practice among hospitals and other organizations. Even though there may not be evidence to support the pros, there is not any easily found evidence to support the cons either so my practice has to rely on critical thinking and the current common practices of other infusion therapy professionals.
When I scoured through my INS textbook, I did find guidance to support cleaning the hub, where it stated on page 503, "The 2009 Joint Commission National Patient Safety Goals have a specific recommendation to use a standardized protocol to disinfect catheter hubs and injection ports prior to accessing the port." Also, in the prodecure description for a needle to hub blood draw, it specifically lists clamping the catheter, removing the injection cap, and cleaning the hub with alcohol. This reassures me that it is a safe and useful step.
Thank you again for helping me to think through this and I welcome any additional discussions on this topic
Tammy
Tammy Rooke RN BscN CCHN(c)