When my daughter restarted TPN (IV nutrition) at age three, there were not many options available for cleaning or protecting the end of the cap (valve or hub) on her central line. We had a choice of alcohol swabs or rather expensive, drippy huge Chloraprep® applicators and Frepps®. To protect the end of the line, which always seemed to dangle right near her GJ tube and diaper, we had to resort to tape, plastic wrap, and creativity.
In the past few years, many new products have come out that make cleaning and protecting your central line cap much easier. Here are just a few of them.
While friction is the most important component of cleaning a cap, many families prefer to use a product containing chlorhexidine to further disinfect the cap. Chlorhexidine is more effective against some of the more challenging bacteria, including Clostridium difficile, and has a residual protective effect, even after the product has dried. While Chlorhexidine has not been studied extensively as an agent to scrub the hub, with only limited data mostly involving NICU patients, it has been proven significantly more effective than alcohol in preparing and disinfecting the skin at the line site.
In the past, the only options for Chlorhexidine have been wands, large scrub brushes, and swab sticks, all of which are great for cleaning skin, but not so helpful in cleaning the end of the cap. Wands and scrub brushes tend to be overly wet, while swab sticks make complete coverage very difficult.
A newer option, produced by Professional Disposables International (PDI), is the Chlorascrub™ wipe. These are identical to a standard alcohol wipe, except that they also contain three percent chlorhexidine. While more expensive than alcohol wipes, they are significantly cheaper than most other chlorhexidine products on the market.
When using chlorhexidine on a central line, a minimum of two percent chlorhexidine gluconate is preferable. Currently, Chlorascrub™ is the only US product with this higher level of chlorhexidine.
Many children with central lines also have ostomies, feeding tube stomas, or wear diapers. Unfortunately, in most cases, a tunneled central line that is not in use will dangle right into the stoma or diaper area, making it likely to be contaminated by stool, bacteria or yeast from the gut, or urine. In addition, some children may grab the line with their hands or otherwise expose the cap to dirt and bacteria.
Several companies have developed products to combat this problem. The two currently on the market are the orange SwabCap® from Excelsior Medical, and the green Curos® Port Protector from Ivera Medical.
Both of the products currently available are small cover caps with a foam sponge inside saturated with alcohol. They work with any luer-style hub. The caps provide a physical barrier to protect the end of the central line, and the alcohol within the caps continuously cleans the hub. SwabCap® also comes available in kits with prefilled saline flushes.
While the manufacturers claim their products can be used in lieu of standard scrubbing of the hub, most nurses, physicians, and parents advise you to continue to scrub the hub with either chlorhexidine or alcohol when accessing the line.
There is some concern about the small size of these caps, as they present a choking hazard to young children or patients with developmental delays. Neither product should be used in this situation. The Curos® Port Protector is slightly safer in that it actually twists on, but both are relatively simple to remove.
When it is time to access the line, the cap protector is simply removed and discarded, and the line is accessed as usual.
A similar product to the disinfecting covers described above is the new SiteScrub from Bard. While it looks very similar, it is not intended to be left on the end of the line. Instead, this device is a new way to scrub any hub without touching it.
The device covers the end of the line, allowing alcohol to cleanse all of the crevices, using a standard ten-second friction scrub. It works on valves and any female or male end, including an uncapped line, and even on injection ports.
We hope these products will help you to keep your line safe and clean! All should be available through your home infusion company.
Copyright 2010 Complex Child E-Magazine. All Rights Reserved.
The information on these pages is not a substitute for appropriate medical care. Please contact your child's physicians before making any changes in your child's care. Complex Child is for research purposes only and does not constitute medical advice.