The CDC guidelines do state that chlorhexidine is the skin
prepping agent that is preferred and they did not distinguish between
peripheral and central lines. So it would seem to me that this should
be used on both. Chlorhexidine agents contain alcohol and have
instructions to scrub for 30 seconds. At the recent AVA meeting, Dr.
Maki stated that catheter hubs should be scrubbed with alcohol for 15
seconds. If they will not do the 15 sec with plain alcohol, they
certainly will not do the 30 sec with chlorhexidine. This demands some
training and a strong performance improvement approach because this is
a major source of CRBSI.
For the promethazine issue, use Mosby's Intravenous Medications
book written by Gahart and Nazareno. Many of the legal cases I review
are involving promethazine. One just settled last week. The rationale
for dilution is to prevent the entire dose of med to infiltrate before
it is recognized. This instructor is setting her students up for
failure with her attitude. It does not require a policy and is
considered nursing judgment where I come from to dilute any
medication. Lynn
At 10:18 AM -0800 3/9/06, Tami Spaeder wrote:
Questions for the group:
2. We have the ability to now use the Chloroscrub Swabs in our hospital. They are, however, more expensive than alcohol swabs. We are trying to decide what to ask our hospital for regarding what we need and what we would use the swabs for. Most of our nurses don't spend the required amount of time swabbing hubs/caps with the alcohol swabs. Is anyone else switching over to these swabs in place of the alcohol swabs? And, if you are, are you using them for all IVs or just for central lines?
1.Our local college has clinical for the nursing students at our hospital. At a recent staff meeting one of the instructors said she will not require her students to dilute IV Phenergan unless we make a policy. In looking up Phenergan in two Mosby's we have, we found one states to dilute and the other says it is optional to dilute before giving. Our PICC team knows the affects Phenergan if it infiltrates into the tissues. I look at this as being a normal, common sense 'nursing consideration' for a medication. Many medications have 'nursing considerations', they don't all need a policy to back it up. Any thoughts?
Tami Spaeder, RN, BSN
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
