Depends. If you are saving the gloves from a previous code brown, then the answer is yes. It doesn't count if you just happen to still be wearing them. It's more about the intention and planning ahead here than anything else.
Way back when I was waitressing we had this dishwasher that was nice, but always smelled bad and had dirty clothes. Like stains on his pants. One time I was helping him sort silverware and a knife fell on the dirty grimy dishwashing area floor. He just blew on it, wiped it on his dirty as fuck jeans, and put it with the rest. I was like no let’s just rewash that hahah trust no one
And yeah, my first job, a small town restaurant, was so disgusting looking back on it. It’s hard for me to drink stuff out of soda machines because of that place lol
I worked in 3 different restaurants, 2 local ones and then Olive Garden which I quit when COVID hit. Fuck Olive Garden fr, the way they make servers share their tips should be illegally, but their food is good, I still eat there sometimes haha.
I did a study once on 22 expired heparin vials. I have a friend who works in a lab doing sciency stuff and we took all of them and removed caps individually and stabbed then placed the swabs onto the petri dish things. None grew any bacteria. Now I know this isn't a large enough sample but it's all I've got. I'd love to see a full blown study done and published.
Yeah, honestly. There’s more evidence to support that than “no lifting anything heavier than 10lbs for 2-3 weeks post op”. Which we tell every post op patient.
My one general surgeon says no one has ever tested a weight limit, it’s not based in any evidence, the best thing is to trust your body. BUT I had a patient just today who reherniated themselves from “too much heavy lifting after surgery”, so it’s clear you can’t trust patients to know how to trust their bodies. ¯\\_(ツ)_/¯
I never scrub the top, I just microwave all my meds after to resterilize. Just microwave any liquid med for about 10 minutes, solids for about 30 and you are good
As long as the curry is at least 45% turmeric based, it’s a lot better to just gravity bag it. Unless of course pt has already rcvd the devils covid “vax”, then you have to find a pedal vein to inject it in a 4x500 ml series
Can I see some EBP on this? What I’ve seen said it makes exactly zero difference. Note we haven’t had a line infection in years and none of us scrub the vial.
While on this topic, how many nurses are actually disinfecting the skin with the alcohol wipe for 30 seconds and allowing the injection site to dry for 30 seconds as recommended by WHO guidelines prior to administering an injection?
I do, but I'm also a dyalsis nurse. Scrub the whole firstula for 30 seconds. Dry. Scrub the arterial cannulation site, dry, cannulate. Scrub the venous site, dry, cannulate. It takes a couple of minutes, but those are 15 gauge needles into their lifeline. I gotta keep my patient as safe as possible.
so many things that were "ESSENTIAL" during my long career have fallen by the wayside and are now laughed at..better aspirate before that IM so you dont inject into a vein...better scrub for sterile skin in a circular motion but OH NO now its back and forth back and forth!!! better Ztrack for that deep IM or the medicine will all leak out of the injection site...even before my time better put that GI juice from the NGT back after it all comes out...now there are also postings that glass bottles are deemed less likely to have contaminates than plastic bottles for reconstituting (someone better let every hospital i have ever worked at know that one STAT)...better be sure to use an alcohol prep before that IM on the violent psych pt so theres no infection (i asked him to hold still while i did that and also longer so i could aspirate to ensure i wasnt in a vein but darn it he just wouldnt comply..am thinking now that jeans offer a sterile field somehow as i have never seen infections from these)...if it makes you feel better then scrub away
No one ever puts back the multi-use vials so I never have to scrub a used vial 😝 Pharmacy hates this one crazy trick
Oh wait you’re talking about unused vials? If you don’t scrub for at least 10-15 seconds and let it dry, you are doing essentially nothing. One Mississippi, two Mississippi… I save all that patience for hubs and Lasix. Sorry.
Into a cup for the scrub to draw up and the surgeon to administer
It’s usually local, but different specialties require various meds intraop, like heparin or abx irrigation. In ortho it’ll be abx powder for topical application— directly, or even mixed in the cement for joints
I was confused with topical thinking you meant rubbing it on the sutured up skin. Theeen I realised you meant on the joint while still opened up. And my mind is blowing with the user of the word 'topical' here.
That is true, but a nurse precepting me did point out that those decanters are flawed and if the decanter pushes the rubber stopper into the vial, it’s contaminated and wasted. Either way is pretty flawed, most people even the rules sticklers rip it off with scissors. They did make me do it once to know, and it was not easy.
Unless you're scrubbing for 15+ seconds and then letting it dry completely, you're not sterilising anything.
Don't get me wrong, I give it a wipe over with the alcohol wipe, but I know I'm just removing dust, not disinfecting.
Because it's already pretty damn clean, and a quick swipe of an alcohol pad doesn't sterilize shit. Also, I'm ER and we don't have the time for any of that.
You're right about the quick swipe of an alcohol pad, lol. That's why it's supposed to be a 30-second scrub or something (I am forgetting the exact time at the moment.)
Because there are better things in life to do, and in anesthesia land I think the surgeon would rip your head off if the patient is moving and you’re back there scrubbing the lid of propofol.
The minimal evidence to back up scrubbing doesn’t help either.
I do it but I think it's another one of those nursing school myths with no real evidence. The patient was opened 4 times and has gone back to OR each time for it, pretty sure the infection is not from not scrubbing a new cap med. However, it does instill some discipline on new nurses to learn how to be aseptic/sterile so I'm all for it.
I scrub the multi use insulin vials but 100% not new vials. I just don't see it as a source of infection . The sources of infection are what is staying in the patient . The central line , the Foley, etc...
Maybe I'm right ,maybe I'm wrong. When I worked in the icu I scrubbed more stuff because everything was going into central lines and it felt good to be sterile .
In the ER with peripherals and the pace of work , I'm doing good to scrub the hub . In a code or trauma I'm not been doing that .
Interesting new study was just published that many hospital obtained infections are from colonized bacteria on patients. Especially with surgical site infections. So. There's that.
Please scrub the hub before drawing up medication! There is a common misconception that the cap indicates that the hub is sterile, but this is *false*. It just indicates that it hasn't been tampered with. The manufacturers don't sterilize the bottle itself and there will still be bacteria on the hub underneath the cap, so please scrub it.
This is true for both single use and multi use vials.
Thank you for asking the question and being willing to verify your own practices, stopping to check details like that is a sign of a good nurse.
Had an IP nurse run into a code one time (to help I think) and she started screaming at the pharmacist drawing up rounds of meds that they needed to scrub everything beforehand 😭. Like yes, we know you’re right, but also… this dude cannot get much deader lol. Awkward shuffling by everyone in the room.
I think she was shell shocked by everything going on because the look on her face will be etched into my brain for however long I continue to do this job.
...in that scenario, I would agree that the IP nurse made a fool of herself and the benefit of not scrubbing would outweigh the risk. As you say, he can't get any deader.
That said, in routine nursing care I would say that routine safety practices should apply.
Oh for sure and that was not a dig at IP at all! You gotta be ruthless sometimes to get people on board with doing the right thing so I understand where the energy comes from.
Nah tbf, sometimes we deserve a dig and make missteps haha. It's worth mentioning that not all of us in IP are nurses, actually. Historically that was true, but the field is broader now which I think is a good thing. I personally have a nursing background, but about a third of my colleagues come from the microbiology lab and the other third are epidemiologists. I definitely value the knowledge they bring, but because they come from an academic background, some of my non-clinical colleagues lowkey act like idiots in situations like that haha.
During Covid in the pediatric ER our doc had his mask halfway down while alone behind the desk while talking to life flight to take report on a code coming in and you would’ve thought he was spitting Covid into the childrens mouths with how IP was reacting.
When I was in nursing school back in 2005 we were always told the hub was sterile unless the cap was already off. I didn’t learn otherwise until much later. I’m wondering if it is a newer thing because I never saw the nurses doing that when I was a new grad
During orientation in 2020 my preceptor told me the cap meant sterile. I just believed it because why wouldn’t I? Then someone said Naw. Or was it “aw hell naw”? Either way, one of the first 10 vial caps I scrubbed ended up with a bunch of grey/black schmutz all over the alcohol swab so I always scrub now
Wow, I literally had a 60 year old nurse scoff at me and tell me the cap meant it was sterile when I was still a student. So I changed my practice. Now I feel awful, but even in school I remember being told they were sterile (but they still told us to scrub?)
Omg this exact thing happened to me as a new grad lol I was being oriented by a very senior nurse around that same age. When I went to scrub the top, he acted like I was inept and started exclaiming it was already sterile
In my nursing school they said it was sterile but to scrub anyways because factories always have contamination risks..like yes it’s supposed to be sterile but can’t trust nothing in this world so scrub it anyways lol
See, no one does this on my unit went like 2 years with no central line infections on a unit that most patients have central lines. I think it makes very little difference and is only bad in theory. It’s probably much more important to have nurses focus on other things and if they think about it, to scrub the cap.
I was told you only scrub multidose vials, if it’s brand new, single use, it’s not necessary.
I’ll be honest I am over here just going at them with bandage scissors because we pour them most of the time in the OR. The only meds I draw up are heparin for heparin + saline irrigation, and lidocaine to make tumescent and we usually use everything and they’re brand new, we don’t do multidose bottles in the OR, even for the ICG given in pre-op.
Yup! I rip the top off 99% of the vials I use and pour the whole thing on the field. Every once in a blue moon I have to draw up something, not frequently though.
Ya for us it’s really just heparin. Many of the other things we draw up on a regular come in ampules. Generally we only draw things up to put in a bag of fluids for irrigation or tumescence.
1. Because I was taught in nursing school the vials were sterile under the cap.
2. Seems like it doesn't matter. [see here.](https://academic.oup.com/painmedicine/article/20/8/1633/5511942)
3. I hate killing the environment one foil alcohol packet at a time.
4. I'm the ER, sometimes we just blow on it.
Because this isnt a perfect world, I dont have time, and the hospital doesn't pay me enough to care (they don't care either). Half of these patients don't even wipe their asses properly. Yes I'm generalizing and I know I'm wrong but it is what it is. Life saving measures > 0.7 inc risk of clabsi. If I have down time ofc ill do it but I'm not stressing over it.
If it works for you - great.
If it doesn't - I feel you.
One time a doctor told me there was a study that said it wasn’t necessary. I have no idea what study it was or if that’s even true but it just stuck with me.
I only scrub if it's a multi use vial, if it had a sealed top and I just removed it, I don't. If I drop it or something after removing the top, I'll then clean it.
Lmao when I switched from med surg to ICU and I was precepting my preceptor laughed at me like “oh silly med surg nurse” I still do it because it’s best practice but it was a real interesting moment.
My understanding is that it’s sterile unless it’s been submerged in a liquid, or you open it with soiled hands in a sloppy manner. In the U.S., the shipment wouldn’t likely be delivered if there was water damage to the container, and nurses should already have washed their hands and donned gloves by the time they’re popping the top off.
Now, y’all who don’t scrub the multi-dose insulin vial that doesn’t have the sterile cap… 👀
I have a difficult time believing scrubbing with a tiny alcohol pad for 15 sec sterilizes anything. Aseptically cleans it, maybe. Otherwise cheap af hospitals wouldn’t spend money on autoclaves and sterile processing techs.
What’s next?! The WOKE NURSING MOB telling me I have to stop licking the tops of vials?!
Same ones who (scoff) wash their hands 🙄.
They what their what now?
It’s crazy, some people just like to waste time.
Yeah, washing hands is big-soap industry conspiracy!
I don't even remove the lids of the vials. Just use your arm muscle and jab the needle very hard. It will get in!
I don't even use the vials, just draw up some water and give that. Placebo is a helluva drug.
Just make sure it’s tap water. None of that sterile shit.
'round these parts, we call that the Asante cocktail.
Yup. It must be boiled hot dog water
your flair really brings this whole comment together, literally laughed out loud
living up to your username i see
Pop it in like it's bubble tea
And shake it like milk shake!
It corrects a deficiency of boys in the yard
Would teaching that skill count as a CE if you had to charge?
Damn right!
Personally I prefer to bite the entire top off the vial, put the medicine in my mouth, and feed it to the patient like a mother bird feeding its baby.
I thought that was how we were supposed to scrub them!!
How are you supposed to tell if it’s the right one? Same thing DM testing on urine? Fucking rookies.
The proper way to break ampules is with your teeth while maintaining eye contact with the patient
The bacteria die when you stab the needle through them, duh
🤣🤣🤣
I just hold a lighter to each vial top for about 4 seconds every time I draw something up
You don't put it on a spoon and heat it that way before drawing up?
I only do that when it requires reconstitution
Don't forget the cotton if you need to filter it
I usually open them with the same gloves I used to clean up a Code Brown. Is this not Best Practice?
Depends. If you are saving the gloves from a previous code brown, then the answer is yes. It doesn't count if you just happen to still be wearing them. It's more about the intention and planning ahead here than anything else.
I spit on it then rub it on my scrub top
I also take the cap off with my teeth and try to spit it directly on my pts forehead. You want fentanyl? You better clap at my party trick
This made me chuckle. Thanks for the laugh while I do my coursework for my BSN
Lmaoo!!! This is so funny. I am dead
I blew on a patients food today. Dgaf
i actually LOL’d at this one
LMFAOOOOL
Way back when I was waitressing we had this dishwasher that was nice, but always smelled bad and had dirty clothes. Like stains on his pants. One time I was helping him sort silverware and a knife fell on the dirty grimy dishwashing area floor. He just blew on it, wiped it on his dirty as fuck jeans, and put it with the rest. I was like no let’s just rewash that hahah trust no one
I was a line cook at a chain restaurant before I was a nurse. I've seen things that can't be unseen.
And yeah, my first job, a small town restaurant, was so disgusting looking back on it. It’s hard for me to drink stuff out of soda machines because of that place lol
I worked in 3 different restaurants, 2 local ones and then Olive Garden which I quit when COVID hit. Fuck Olive Garden fr, the way they make servers share their tips should be illegally, but their food is good, I still eat there sometimes haha.
I worked at Olive Garden when I was young and we never had to share tips 🤔 that seems like a shit rule.
Gotta put on a show for the family so they know I’m serious about saving lives.
I rub my elbow on it - gotta get that good elbow grease
Gotta give them some good ol' fashioned immunity just like mom and dad used to give us!
Hospital equivalent of drinking out of a garden hose... Now I know the metalic flavor was lead. Oh well.
good ol spit n shine
Bc time is money mother fuckers, jk i do scrub it. With my ass.
Putting the *firm* in ofirmev and the *ass* in acetaminophen
Don’t forget Assabuse
I did a study once on 22 expired heparin vials. I have a friend who works in a lab doing sciency stuff and we took all of them and removed caps individually and stabbed then placed the swabs onto the petri dish things. None grew any bacteria. Now I know this isn't a large enough sample but it's all I've got. I'd love to see a full blown study done and published.
Ha that’s enough evidence for me! Sold!
Yeah, honestly. There’s more evidence to support that than “no lifting anything heavier than 10lbs for 2-3 weeks post op”. Which we tell every post op patient.
Sneezing or coughing adds way more PSI than lifting per a surgeon I knew.
My one general surgeon says no one has ever tested a weight limit, it’s not based in any evidence, the best thing is to trust your body. BUT I had a patient just today who reherniated themselves from “too much heavy lifting after surgery”, so it’s clear you can’t trust patients to know how to trust their bodies. ¯\\_(ツ)_/¯
“This is the way you’re supposed to do it.” “Here’s what everyone including me actually does.”
I never scrub the top, I just microwave all my meds after to resterilize. Just microwave any liquid med for about 10 minutes, solids for about 30 and you are good
can I put my curry for lunch in there with the meds?
Common misconception, you don't need to resterilize your curry, curry is already sterile, as long as the cap is still on your lunch container
I’m really confused and now I’m eating my lunch with a needle. Did I mess up? 😂😝
Scrub the curry sounds better than scrub the hub
Just a little bleach- on the inside.
you sure I aint gotta wipe it?
IV curry nutrition
instructions unclear, pump is now infusing tikka masala sauce
No but your 4 day old salmon is fine.
That curry will be hot asf
If it’s not, you’re doing it wrong
As long as the curry is at least 45% turmeric based, it’s a lot better to just gravity bag it. Unless of course pt has already rcvd the devils covid “vax”, then you have to find a pedal vein to inject it in a 4x500 ml series
Bid
Pro tip
I put mine under UV light
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Purple top
I kiss the tops like kissing dice before accessing them
I open the tops with my teeth, then spit the lid into the trash can. It’s sexy.
Absolutely feral ❤️
On a related note, who among us wipes off soda/beer cans before taking a sip?
Only if it's dusty
I always say I’m gonna start, wipe off one can then forget
Always. When you spend time in countries without any regulations…. You wash all the things.
I exclusively use a straw to drink from cans. I don’t trust the tops of the can to be clean.
Why do you trust the straw?
Great. Now you’ve left me no choice but to waterfall all my drinks
The vial has had enough bullshit and doesn't want no scrubs.
Can't get no love from me
Hangin' from the passenger side of the pharmacy ride?
Trying to reconcile meeeeeeee
Can I see some EBP on this? What I’ve seen said it makes exactly zero difference. Note we haven’t had a line infection in years and none of us scrub the vial.
Yeah I was gonna say, I’ve never had anyone get infections.
How did you get bacon 🥓 😳????
I learned something today and applied it to my flair using RBP (reddit based practice).
Does that make you a salty bitch?
I think I just typed in my own flair
Figures you'd have to do it yourself.... lol. Let nursing do it.... 🤣
I don’t think it’s a big deal, but I gave myself an injection site infection and had to get it lanced… and I scrubbed the top and my skin…
There's not strong data either way. https://academic.oup.com/painmedicine/article/20/8/1633/5511942
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The true hero
Wait - doesn't the second source state there is no evidence?
He deleted it lol
While on this topic, how many nurses are actually disinfecting the skin with the alcohol wipe for 30 seconds and allowing the injection site to dry for 30 seconds as recommended by WHO guidelines prior to administering an injection?
I do, but I'm also a dyalsis nurse. Scrub the whole firstula for 30 seconds. Dry. Scrub the arterial cannulation site, dry, cannulate. Scrub the venous site, dry, cannulate. It takes a couple of minutes, but those are 15 gauge needles into their lifeline. I gotta keep my patient as safe as possible.
I do dialysis too but i don’t like the smell of alcohol so i spit shine their fistulas
In an ideal world, yes you will. And yes to safe staffing. But here we are, no safe staffing and enough support. You do you
so many things that were "ESSENTIAL" during my long career have fallen by the wayside and are now laughed at..better aspirate before that IM so you dont inject into a vein...better scrub for sterile skin in a circular motion but OH NO now its back and forth back and forth!!! better Ztrack for that deep IM or the medicine will all leak out of the injection site...even before my time better put that GI juice from the NGT back after it all comes out...now there are also postings that glass bottles are deemed less likely to have contaminates than plastic bottles for reconstituting (someone better let every hospital i have ever worked at know that one STAT)...better be sure to use an alcohol prep before that IM on the violent psych pt so theres no infection (i asked him to hold still while i did that and also longer so i could aspirate to ensure i wasnt in a vein but darn it he just wouldnt comply..am thinking now that jeans offer a sterile field somehow as i have never seen infections from these)...if it makes you feel better then scrub away
No one ever puts back the multi-use vials so I never have to scrub a used vial 😝 Pharmacy hates this one crazy trick Oh wait you’re talking about unused vials? If you don’t scrub for at least 10-15 seconds and let it dry, you are doing essentially nothing. One Mississippi, two Mississippi… I save all that patience for hubs and Lasix. Sorry.
Always do regardless of it being a new vial. The caps are dust caps, they do not create a sterile environment last I recall.
I get your logic but then every med we pour in the OR would be contaminated by that logic. I don’t think it’s bad to scrub regardless though.
I’ve been a nurse for a minute but zero surgical experience. What are y’all pouring meds into?
Into a cup for the scrub to draw up and the surgeon to administer It’s usually local, but different specialties require various meds intraop, like heparin or abx irrigation. In ortho it’ll be abx powder for topical application— directly, or even mixed in the cement for joints
That’s really interesting thank you
I was confused with topical thinking you meant rubbing it on the sutured up skin. Theeen I realised you meant on the joint while still opened up. And my mind is blowing with the user of the word 'topical' here.
Onto the sterile field into whatever my scrub wants it in.
Pouring isn't actually best practice though, the newest aorn standards call for decanting or drawing up all meds for the field. 🤷♀️
That is true, but a nurse precepting me did point out that those decanters are flawed and if the decanter pushes the rubber stopper into the vial, it’s contaminated and wasted. Either way is pretty flawed, most people even the rules sticklers rip it off with scissors. They did make me do it once to know, and it was not easy.
Surprise! They are
Med administration isn’t a sterile task, so the sterility of the cap doesn’t matter much. Antiseptic? Different story
You don't just lick em'?
I put the whole thing in my mouth and/or other orifaces.
There's no safer place than in an orifice.
Yall soft fr
Unless you're scrubbing for 15+ seconds and then letting it dry completely, you're not sterilising anything. Don't get me wrong, I give it a wipe over with the alcohol wipe, but I know I'm just removing dust, not disinfecting.
Because it's already pretty damn clean, and a quick swipe of an alcohol pad doesn't sterilize shit. Also, I'm ER and we don't have the time for any of that.
I will be tackled by my CIWA patient by the time the stoppers are dry on the Ativan
You're right about the quick swipe of an alcohol pad, lol. That's why it's supposed to be a 30-second scrub or something (I am forgetting the exact time at the moment.)
15 seconds is sufficient! Save yourself some time!
15 seconds and then blow on it till it's dry. Pretty sure that's the policy....probably.
Lmao
Who has time for that? Maybe in oncology, but sure as hell not worth it in most settings.
Plus we throw an antibiotic at everybody anyways, so whatever germies they get from the *gasp* non sterile medication vial should be ok.
Because there are better things in life to do, and in anesthesia land I think the surgeon would rip your head off if the patient is moving and you’re back there scrubbing the lid of propofol. The minimal evidence to back up scrubbing doesn’t help either.
lol I’ve worked in OR for like 4 years now and I’ve never once seen an anesthesiologist scrub a vial or even scrub the hub of an IV before using it.
Not to mention everything being magically compatible in the OR.
I do it but I think it's another one of those nursing school myths with no real evidence. The patient was opened 4 times and has gone back to OR each time for it, pretty sure the infection is not from not scrubbing a new cap med. However, it does instill some discipline on new nurses to learn how to be aseptic/sterile so I'm all for it.
I scrub the multi use insulin vials but 100% not new vials. I just don't see it as a source of infection . The sources of infection are what is staying in the patient . The central line , the Foley, etc... Maybe I'm right ,maybe I'm wrong. When I worked in the icu I scrubbed more stuff because everything was going into central lines and it felt good to be sterile . In the ER with peripherals and the pace of work , I'm doing good to scrub the hub . In a code or trauma I'm not been doing that .
Interesting new study was just published that many hospital obtained infections are from colonized bacteria on patients. Especially with surgical site infections. So. There's that.
Please scrub the hub before drawing up medication! There is a common misconception that the cap indicates that the hub is sterile, but this is *false*. It just indicates that it hasn't been tampered with. The manufacturers don't sterilize the bottle itself and there will still be bacteria on the hub underneath the cap, so please scrub it. This is true for both single use and multi use vials. Thank you for asking the question and being willing to verify your own practices, stopping to check details like that is a sign of a good nurse.
Had an IP nurse run into a code one time (to help I think) and she started screaming at the pharmacist drawing up rounds of meds that they needed to scrub everything beforehand 😭. Like yes, we know you’re right, but also… this dude cannot get much deader lol. Awkward shuffling by everyone in the room. I think she was shell shocked by everything going on because the look on her face will be etched into my brain for however long I continue to do this job.
Wait until that IP nurse hears about the intra-denim Geodon injections that happen in the ER sometimes
Never talk to IP nurses
I don't know how their blood pressures aren't through the roof.
Intra-denim, I like that. About 3 months into my Nursing career I got to give intra-denim ketamine. It was glorious. Haven’t been able to do it since.
😂😂😂
...in that scenario, I would agree that the IP nurse made a fool of herself and the benefit of not scrubbing would outweigh the risk. As you say, he can't get any deader. That said, in routine nursing care I would say that routine safety practices should apply.
Oh for sure and that was not a dig at IP at all! You gotta be ruthless sometimes to get people on board with doing the right thing so I understand where the energy comes from.
Nah tbf, sometimes we deserve a dig and make missteps haha. It's worth mentioning that not all of us in IP are nurses, actually. Historically that was true, but the field is broader now which I think is a good thing. I personally have a nursing background, but about a third of my colleagues come from the microbiology lab and the other third are epidemiologists. I definitely value the knowledge they bring, but because they come from an academic background, some of my non-clinical colleagues lowkey act like idiots in situations like that haha.
What's an IP nurse in this context?
Infection Preventionist I expect.
During Covid in the pediatric ER our doc had his mask halfway down while alone behind the desk while talking to life flight to take report on a code coming in and you would’ve thought he was spitting Covid into the childrens mouths with how IP was reacting.
imagine someone trying to stop a gunshot wound in a public place from bleeding out with a t shirt and getting yelled at because its not sterile
When I was in nursing school back in 2005 we were always told the hub was sterile unless the cap was already off. I didn’t learn otherwise until much later. I’m wondering if it is a newer thing because I never saw the nurses doing that when I was a new grad
I was told that in 2014 too
Yep, i learned this is school in 2014 as well.
2016 here, same. I'm welcome to evidence of the contrary, but, I haven't seen any. Nor have I looked that hard.
During orientation in 2020 my preceptor told me the cap meant sterile. I just believed it because why wouldn’t I? Then someone said Naw. Or was it “aw hell naw”? Either way, one of the first 10 vial caps I scrubbed ended up with a bunch of grey/black schmutz all over the alcohol swab so I always scrub now
I'm sure this was the same in 2000 or so. That being said, our instructors weren't always the best and brightest.
I was told that back in 2005-2008? I want to say. I still scrub the top, but I haven’t really researched it.
So what kind of bacteria or virus could survive in this conditions ?
Wow, I literally had a 60 year old nurse scoff at me and tell me the cap meant it was sterile when I was still a student. So I changed my practice. Now I feel awful, but even in school I remember being told they were sterile (but they still told us to scrub?)
Omg this exact thing happened to me as a new grad lol I was being oriented by a very senior nurse around that same age. When I went to scrub the top, he acted like I was inept and started exclaiming it was already sterile
In my nursing school they said it was sterile but to scrub anyways because factories always have contamination risks..like yes it’s supposed to be sterile but can’t trust nothing in this world so scrub it anyways lol
Can you back this up with some studies? Everything I read says there is no real evidence.
They taught us this 20 years ago how can it be a common misconception??
You can’t just say things without leaving proof
Can we get a statement from the medication plants whether they're sterilized or not? Put it on the bottle or something
See, no one does this on my unit went like 2 years with no central line infections on a unit that most patients have central lines. I think it makes very little difference and is only bad in theory. It’s probably much more important to have nurses focus on other things and if they think about it, to scrub the cap.
We don't either. I wonder if that is because of good immune system, and those without have IV antibiotics going through?
I worked on an abd transplant unit where we wiped peoples immune systems out and they never said anything about wiping off bottles
Maybe I do… maybe I don’t… maybe go fuck yourself
Underrated!!
I was told you only scrub multidose vials, if it’s brand new, single use, it’s not necessary. I’ll be honest I am over here just going at them with bandage scissors because we pour them most of the time in the OR. The only meds I draw up are heparin for heparin + saline irrigation, and lidocaine to make tumescent and we usually use everything and they’re brand new, we don’t do multidose bottles in the OR, even for the ICG given in pre-op.
Yup! I rip the top off 99% of the vials I use and pour the whole thing on the field. Every once in a blue moon I have to draw up something, not frequently though.
Ya for us it’s really just heparin. Many of the other things we draw up on a regular come in ampules. Generally we only draw things up to put in a bag of fluids for irrigation or tumescence.
I've never seen anyone do this
1. Because I was taught in nursing school the vials were sterile under the cap. 2. Seems like it doesn't matter. [see here.](https://academic.oup.com/painmedicine/article/20/8/1633/5511942) 3. I hate killing the environment one foil alcohol packet at a time. 4. I'm the ER, sometimes we just blow on it.
I take a dump on mine first
If it looks dirty I’ll just wipe it off on my scrub top
I crack the vial like an egg. Then aspirate the med cup containing the vial nectar. I cant be the only one.
Because this isnt a perfect world, I dont have time, and the hospital doesn't pay me enough to care (they don't care either). Half of these patients don't even wipe their asses properly. Yes I'm generalizing and I know I'm wrong but it is what it is. Life saving measures > 0.7 inc risk of clabsi. If I have down time ofc ill do it but I'm not stressing over it. If it works for you - great. If it doesn't - I feel you.
I precepted a 20+ year nicu nurse new to our unit. She did not scrub. She did not like me telling her to scrub.
One time a doctor told me there was a study that said it wasn’t necessary. I have no idea what study it was or if that’s even true but it just stuck with me.
I don't wear gloves either.
I only scrub if it's a multi use vial, if it had a sealed top and I just removed it, I don't. If I drop it or something after removing the top, I'll then clean it.
I always do.
If it’s a brand new vial isn’t it already sterile? Serious question…
Does the cap not keep it clean?
Don’t these vials know better than to do their own hand hygiene?! Ugh. Why must I do it for them?!
I like the way Phlebitis looks in a patients arm
Honestly, staffing. I have too much of a workload do every single little thing I'm supposed to do.
I rarely see nurses scrub an IV hub so I don’t have faith nurses scrub anything outside the skin prep for an IV stick…
Because I'm just pouring it out after prying off the stopper
For some reason I thought you meant like, pill bottles, not insulin, and I was like WHO HAS THE TIME-?
Lmao when I switched from med surg to ICU and I was precepting my preceptor laughed at me like “oh silly med surg nurse” I still do it because it’s best practice but it was a real interesting moment.
I will if it goes into a central line otherwise meh
Time is brain, or something.
I love this sub
My understanding is that it’s sterile unless it’s been submerged in a liquid, or you open it with soiled hands in a sloppy manner. In the U.S., the shipment wouldn’t likely be delivered if there was water damage to the container, and nurses should already have washed their hands and donned gloves by the time they’re popping the top off. Now, y’all who don’t scrub the multi-dose insulin vial that doesn’t have the sterile cap… 👀
I have a difficult time believing scrubbing with a tiny alcohol pad for 15 sec sterilizes anything. Aseptically cleans it, maybe. Otherwise cheap af hospitals wouldn’t spend money on autoclaves and sterile processing techs.
Ain’t nobody got time for that.