We are updating our IV policies to reflect the 2011 CDC and INS guidelines. My questions are
1. The CDC guidelines state to prepare skin with chlorhexidine with alcohol for central venous catheter insertion and dressing change and if there is a contradindication to chlorhexidine, to use tincture of iodine, an iodophor or 70% alcohol.
Why do the 2011 (4th ed) INS guidelines only give a choice between chorhexidine and povidone iodine for this?
2. I have searched but cannot find the specific recommendation for how long to prep the skin with alcohol for catheter insertion or dressing change other than in the INS guidelines (3rd ed) which recommends 30 seconds with friction. Where did this recommendation originate?
First, the INS document is a standard of practice, not a guideline. You did not stte what part of the standards document you are reading. See Standard 35, Practice Criteria I. General, G page S44 which lists CHG as the preferred agent, but also includes 1 and 2% tincture of iodine, iodophor and 70% alcohol. There is no evidence-based information about how long to prep the skin with alcohol. 30 seconds is based on CHG research presented to the FDA for product clearance. If using CHG, why do you need to use alcohol alone for either insertion or dressing change? Skin must be clean, e.g. washed with soap and water before insertion if it is visibily dirty. When doing a dressing change, washing is not possible so you could clean it by removing skin oils with alcohol before using CHG. That would be the only time you would need alcohol unless there was a problem in a specific patient for CHG. 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 for replying Lynn...I was basing my question on the procedures outlined in the "Policies and Procedures for Infusion Nursing" and not the INS Standards of Practice which I do not have...but your answer clarifies my question.
Occasionally in the hospice home setting the chlorhexidine prep may not be available if a dressing change or access is needed unexpectedly, thus the question about length of alcohol prep alone.
Celeste O. Phillips, MN, RN-BC Hosparus, Inc Louisville KY
The INS Policy and Procedure book was also revised at the same time as the INS standards. So you do need the most recent edition of both, which were released only a few weeks ago. One thing I have always heard when prepping with alcohol is to use enough pads and scrubbing til the pad comes away clean without visible dirty. You may be dealing with patients that have fragile skin and all alcohol acts to dry up the lipids in the epidermis - so excessive scrubbing could add to the infection risk, not reduce it. 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