Cleaning your IV site

[croaker260]

If you have the time and circumstances, then yes, that would be the ideal application process. But again, there are a lot of times that you don't have that luxury. And if you're rushing someone to trauma surgery, they're going to be getting a buttload of 3G cephalosporins anyhow. I wouldn't delay their care or transportation waiting for iodine to dry. And again, I expect chlorhexadine to become the standard in the near future.

I think the old technique of iodine followed by alcohol was mostly aesthetically driven. It just seems intuitive to "clean" the iodine off, if you don't understand how they work. Lord knows I did it that way for a very long time.

Oh I am fully aware that time constraints..but I agree, if you clean your likely site before you put on the TQ, then set up your stuff, then TQ, that can take 2 minutes easy if your (like many things in EMS ) cheorograph it right.

[Dustdevil]

Oh I am fully aware that time constraints..but I agree, if you clean your likely site before you put on the TQ, then set up your stuff, then TQ, that can take 2 minutes easy if your (like many things in EMS ) cheorograph it right.

I like that term! It should be used more during paramedic education!

It's not enough just to do all the right things. It is important to do them in the order that optimises their efficacy!

[Bernhard]

I like this forum, making you check over the basic things...

Just took a look in our local used skin desifection's product data sheet to verify. It's an alcohol ("Propan-2-ol", Isopropanol) based desinfectant with bactericide (incl. MRSA), fungicide, tuberculocide, virucide (not all but incl. HBV, HIV, HCV) and sufficient against rotavirus. We have it as 250ml spray in our EMS equipment, in our disaster response equipment we carry alcohol pads containing the same. The data sheet states for punctuation/i.v. access on arms or legs: "soak the skin wet, wait 15 seconds, wipe dry".

On dirty skin we first use the agent to mechanically clean the skin and then repeat above procedure.

However, the data sheet states other times for other puncture locations and OP usage (up to ten minutes). Only for i.v. access at arms and legs 15 seconds seem enough (due to low density of sebaceous glands there). Significant reducing of germ density lasts over 24 hrs, so I'm on the safe side when cleaning the skin and then start searching for a vein as I usually do, thus giving the desinfectant even more time than 15 seconds. I didn't measure "access time" yet, so I only can assume that if I take my time its about 1-2 minutes, sometimes longer, sometimes shorter.

The spray is optionally available with an additional marker fluid (maybe helping in identifying veins also), but that's not what we have. The use of iodine is not common here in prehospital settings.

For the "choreography" part: in the emergency backpacks of my volunteer squad (no transportation first responder plus disaster response) we have it organized in such a way that all we need for i.v. access is collected in one sub-bag (desinfection, i.v. needles of three sizes, crystalloid fluid, tape, swab). Makes things easy - just take the little pack out and work on the patient's side, leaving the big backpack for the other providers and/or out of the narrow space. Unfortunately this tiny little idea didn't made it to my countie's EMS provider yet...