Cleaning your IV site

[tcripp]

How fast does betadine work?

http://www.purduepharma.com/PI/NonPrescription/A6910B13.pdf

No specific time frame identified.

[usalsfyre]

Betadine is supposed to dry on the site (out of the Brady medic books, don't have the reference handy)

[crotchitymedic1986]

The CDC disagrees.

Perhaps when when you make such comments you can show us the respect of citing them so that it doesn't appear that you are simply passing on rumor as fact.

http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

"Alcohol can prevent the transfer of health-care–associated

pathogens (25,63,64). In one study, gram-negative bacilli were

transferred from a colonized patient’s skin to a piece of catheter

material via the hands of nurses in only 17% of experiments

after antiseptic hand rub with an alcohol-based hand

rinse (25). In contrast, transfer of the organisms occurred in

92% of experiments after handwashing with plain soap and

water. This experimental model indicates that when the hands

of HCWs are heavily contaminated, an antiseptic hand rub

using an alcohol-based rinse can prevent pathogen transmission

more effectively than can handwashing with plain soap

and water."

Does this tell the entire story? Of course not. But relying on reputable sources for such information over believing whatever crap your partner happens to mumble in his/her sleep is certainly a beginning.

Actually, the cited document is pretty interesting if you have a few minutes to spend reading it.

Dwayne

Dwayne, so quick to judge me. If alcohol is so good why don't we sterilize surgical instruments with it. Why don't we soak our laryngoscope blades or other soiled EMS equipment in it ? Put your money where your mouth is, the next time you work an arrest, I want you to clean that laryngoscope blade with an alcohol prep, let it dry, and then put it in your mouth --- betting that is not going to happen. Makes me wonder why surgeons use all that betadine in the OR, why not just hit that site with some alcohol preps ?

Now if YOU had done more research rather than just accept the first article that popped up when you googled it, you will find that alcohol has a hard time killing lipophilic viruses (HIV, RSV, and Hepatitis- because of the virus'lipid shell, and alcohol also has a tough time with hydrophylic viruses (Poliovirus, Rhinovirus, and Hepatits A)because of it's protein shell. If you want to knock the dust bunnies and boogers off someone's hand, use alcohol. If you want to use an aseptic technique, use something else.

Edited April 12, 2011 by crotchitymedic1986

[DwayneEMTP]

Dwayne, so quick to judge me. If alcohol is so good why don't we sterilize surgical instruments with it. Why don't we soak our laryngoscope blades or other soiled EMS equipment in it ? Put your money where your mouth is, the next time you work an arrest, I want you to clean that laryngoscope blade with an alcohol prep, let it dry, and then put it in your mouth --- betting that is not going to happen. Makes me wonder why surgeons use all that betadine in the OR, why not just hit that site with some alcohol preps ?

Now if YOU had done more research rather than just accept the first article that popped up when you googled it, you will find that alcohol has a hard time killing lipophilic viruses (HIV, RSV, and Hepatitis- because of the virus'lipid shell, and alcohol also has a tough time with hydrophylic viruses (Poliovirus, Rhinovirus, and Hepatits A)because of it's protein shell. If you want to knock the dust bunnies and boogers off someone's hand, use alcohol. If you want to use an aseptic technique, use something else.

I didn't claim that it is 'so good.' I debated your claim that it is no better than anything else that is moist. And the CDC website is hardly Wikipedia, nor the first thing that came up.

And for the record, the shit you cited did in fact pop up in the first Google search I did...so..down boy. We've seen your posts, no one thinks that you're talking from your own knowledge..despite the fact that you have again failed to cite the sources for your claims and pass Googled info off as your own knowledge.

We're debating IV sites, not the best product pre hip replacement surgery.

Again...reread man..I never claimed it was better than Betadyne, never claimed it was the cat's meow, I simply disputed your ridiculous claim that it is no better than water.

And will I put the alcohol cleaned laryngoscope in my mouth? Absolutely, 'cause to the best of my knowledge few, if any, pathogens get us ill orally. Would I touch it to my eye, or put it in my nose? Nah... I never claimed it would be sterile, just disinfected.

You know Crotchity, I keep hoping that at some point your arguments will improve. That maybe someday we'll hit upon something that you'll care enough to make an intelligent, passionate argument about. I've seen you do one or the other many times, but never both together. I truly keep hoping that these types of arguments are not as good as you get...

Dwayne

[Bieber]

I just use alcohol preps on my IV starts. I also make a habit of wiping down the finger I'm using to palpate the vein with, so I can double check the site location one last time after I've cleaned it without contaminating the site. Unfortunately, lately my IV skills have been crappy. I think the last time I worked I was two for five.

[tcripp]

Gotta love the CDC:

Guidelines for the Prevention of Intravascular Catheter-Related Infections - http://www.cdc.gov/h...elines-2011.pdf

Excerpt:

Skin Preparation

1. Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, or alcoholic chlorhexidine gluconate solution) before peripheral venous catheter insertion [82]. Category IB

2. Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes. If there is a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70% alcohol can be used as alternatives [82, 83]. Category IA

3. No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin. Unresolved issue.

4. No recommendation can be made for the safety or efficacy of chlorhexidine in infants aged <2 months. Unresolved issue

5. Antiseptics should be allowed to dry according to the manufacturer's recommendation prior to placing the catheter [82, 83]. Category IB

[island emt]

One of our hospitals went on a campaign to eliminate staff infections & MRSA a few years back and tracked in the field IV starts for over a year. There results showed that alcohol only has a 3% rate of infections and those with chloroprep ampules had a 1.1 % rate at three days in.

They were working at reducing IV changes when we bring the patients in with good aseptic technique start from the field and a general overall infection rate in patients in-house.

Their infection control committee went to every department and made recommendations for changes to reduce the MRSA rate and other types of bacterial infections.

If the patient is grossly contaminated , I will wash with sterile saline first then wipe with an alcohol wipe followed by the chloroprep ampule.

It usually takes about a minute to air dry.

I have seen a pt with a severe reaction to the betadine/ providine swabs , so we no longer use them.

[fiznat]

Of note, since it always comes up:

Peripheral intravenous catheters started in prehospital and emergency department settings.

J Trauma Nurs. 2008 Apr-Jun;15(2):47-52

http://www.ncbi.nlm.nih.gov/pubmed/18690133

The purpose of this study was to determine the rates of phlebitis in trauma patients according to where the peripheral intravenous catheter (PIVC) was inserted in a prehospital setting or in an emergency department setting. Variables investigated also included where the catheter was anatomically placed, the gauge of the catheter, and the patients' Injury Severity Score. The overall phlebitis rate was 5.79%. The rate of phlebitis was 2.92% when started by an RN in the emergency department, 6.09% when started by an intermediate emergency medical technician and 7.78% when started by a paramedic in prehospital setting. There was no significant difference in the rates of phlebitis when a chi-square analysis was performed. In addition, no variables predicted phlebitis no matter where the PIVC was started when a regression analysis was conducted. Even though the Centers for Disease Control and Prevention suggests removing the PIVC within 48 hours if placed under emergency situations, the phlebitis rates of trauma patients in this study meet the benchmark of best practice. Perhaps removing the PIVC within 48 hours of placement should be reconsidered.

[NYCEMS9115]

The brown stuff first then the wet clear stuff to clean up the brown stuff. You may have to repeat this depending on the cleanliness of the stickee...

[PCP]

We use iodine and then alcohol for cleaning the IV site.