From the Guidelines
To clean a very contaminated Intravenous (IV) site, active disinfection with alcohol-based chlorhexidine gluconate swab pads is the most effective method, as it has been associated with lower rates of central line-associated bloodstream infections (CLABSI) 1. When cleaning the site, it is essential to apply mechanical friction using an alcoholic CHG preparation or 70% alcohol for 5 to 15 seconds, as this has been shown to be effective in reducing CLABSI rates 1. Some key considerations for cleaning and maintaining IV sites include:
- Using ultrasound guidance for catheter insertion to decrease the risk of noninfectious complications linked with CL placement 1
- Applying dressings containing chlorhexidine for CLs in patients over two months of age, as this has been shown to significantly reduce CLABSIs 1
- Replacing dressings every 7 days for nontunneled CLs, or more frequently if the dressing becomes soiled, loose, or damp 1
- Disinfecting the catheter hubs, needleless connectors, and injection ports before accessing the catheter, using either an antiseptic-containing cap or mechanical disinfection with an alcoholic CHG preparation or 70% alcohol 1 It is also important to note that the use of topical antibiotic ointments or creams on insertion sites is not recommended, except for dialysis catheters, due to the potential for promoting fungal infections and antimicrobial resistance 1. Overall, a systematic approach to cleaning and maintaining IV sites, using evidence-based methods and considering individual patient factors, is crucial for reducing the risk of CLABSI and promoting patient safety.
From the Research
Cleaning a Contaminated IV Site
To clean a very contaminated Intravenous (IV) site, it is essential to follow proper wound care techniques. The goal is to reduce the microbial burden and promote healing.
- Wound Irrigation: Wound irrigation is a technique used to remove debris, bacteria, and other contaminants from the wound site 2. Various irrigants can be used, including saline, povidone-iodine, and chlorhexidine. However, the effectiveness of these irrigants in preventing surgical site infections is still a topic of debate 2.
- Antiseptic Solutions: Antiseptic solutions, such as povidone-iodine, octenidine, and polyhexanide, can be used to reduce the risk of infection 3. These solutions have been shown to be effective against a wide range of microorganisms, including multi-drug resistant pathogens.
- Hydrogen Peroxide: Hydrogen peroxide has been used as a wound cleaning agent, but its effectiveness is still being studied 4. A study found that hydrogen peroxide promoted granulation tissue formation and reduced infection in acute wounds.
- Negative Pressure Wound Therapy (NPWT): NPWT is a technique that uses negative pressure to promote wound healing 5. It has been shown to be effective in managing surgical site infections, particularly in patients with diabetes mellitus.
Considerations for Cleaning a Contaminated IV Site
When cleaning a contaminated IV site, it is essential to consider the following:
- Assess the wound: Assess the wound to determine the level of contamination and the presence of any debris or bacteria.
- Choose the right irrigant: Choose an irrigant that is effective against a wide range of microorganisms and is suitable for the type of wound.
- Use antiseptic solutions: Use antiseptic solutions to reduce the risk of infection, but be aware of the potential risks and side effects.
- Consider NPWT: Consider using NPWT to promote wound healing, particularly in patients with diabetes mellitus or other underlying conditions that may impair wound healing.