This document summarizes an online chat about intravenous (IV) therapy topics between various nurses. Participants introduced themselves and their locations/specialties. They discussed using an otoscope to find veins, flushing PICC lines without blood return, and hub scrubbing techniques. New devices like alcohol-impregnated connectors were debated on their potential to help prevent central line-associated bloodstream infections. Standardization of central line care policies across hospitals was also discussed.

1. Welcome everyone toIVchat!Let'sbeginwithintros,tell us
abouturselvesin<140! #IVchat IVchat
Morningall (my time) Glen,NUM- Day OncologyUnit,
Brisbane,Downunda.Wed11 am here,working,fullclinic,may
be in andout #ivchat chemosabe
Good to see all - VernoninNewOrleans - Critical Care,Nursing
Historyand Hospital Nightmare :) here itlearnfrom#IVchat nursingpins
Hi all,I'm Cora,infusionnurse andmoderatorforIV chat!
Welcome!!#IVchat InfusionNurse
I'm Crystal - I do social mediaforthe NursingLinkcommunity!
#ivchat NursingLink
@chemosabe Hi Glen,thanku forjoiningurfirstIV chat. we're
so happyu can jointoday!#IVchat IVchat
Hi! I'm Teresa,fromLongIsland,NY anda staff development
instructor#ivchat NurseEducator
@NursingLinkWelcomeCrystal,thanksforjoining!Goodtosee
u! #IVchat IVchat
@IVchatthanks,have keptmissingitforpast 6 monthsor so...
#ivchat chemosabe
@nurseeducatorGoodtosee ya. #IVchat nursingpins
as always,gladto be here #ivchat NursingLink
@nurseeducatorHi Teresa,thanksforjoining!Welcome!
#IVchat IVchat
@nurseeducatorHi Teresa,goodto see utonite.#IVchat InfusionNurse
@nursingpinsHeyVernon,howdy!#IVchat InfusionNurse
Yay, so happyto see a lotof ourtwittercolleaguesontonite.
Thank youfor joining.Firsttopiccomingupnext#IVchat IVchat
@nursingpinsgoodtosee youtoo!#ivchat NurseEducator
@InfusionNurse Happytobe here!Hopefullyadelayedvisit!
#ivchat NurseEducator
Topicswill be numbered,pls,prependw/topic# whenreplying
#IVchat IVchat

2. T1 - Use of otoscope forfindingveins?Urthoughts?any
experience?#IVchat IVchat
T1 - honestly,Ihave notusedanotoscope to helpfind
veins...notsure how touse it.#IVchat InfusionNurse
T1 Have neverusedan otoscope - mayneedto? #IVchat nursingpins
T1 neverdone it...butcan'tsee yit couldn'twork...tendtosend
our diff accessesforu/sguidedcannulae #ivchat chemosabe
T1 - of course,its not an approveduse foran otoscope.#IVchat InfusionNurse
RT @IVchat: Welcome everyone toIVchat!Let'sbeginwith
intros,tell usabouturselvesin<140! #IVchat "interestingchat
to checkout" ctsinclair
T1 but forthat matter,don't mostnursescarry a led
torch/flashlightthese days?#ivchat chemosabe
T1 - itsinterestingbutfoundthisarticle onotherusesof
otoscope..http://bit.ly/gTTP3i #IVchat IVchat
T1 Neverusedone eitherforfindingveinseither!Thinkinglight
mighthelp#ivchat NurseEducator
Nurses:goingonrightnow is#IVchat.Checkit out.#RNchat RNchat
Yes,not forfindingveins.RT@InfusionNurse:T1- of course,its
not an approveduse foran otoscope.#IVchat IVchat
lightnotenoughto illuminate?RT@chemosabe:T1 butfor that
matter,dontmost nursescarry a ledtorch/flashlightthese
days?#IVchat InfusionNurse
Nurses:there'sachat just foryou.starts NOW.findit at #ivchat infoployment
T1 The beamof otoscope lightilluminatethe tissuesof the
arms of younginfantsfacilitate the locationof veins,#IVchat IVchat
T1 (cont) appearas dark linesaccessible for
venipuncture...accdgtothe article..#IVchat IVchat
RT @IVchat: T1 The beamof otoscope lightilluminate the
tissuesof the arms of younginfantsfacilitatethe locationof
veins,#IVchat InfusionNurse

3. @InfusionNurse probablynot...justtryingtobe creative,
besides,don'tknowthatIhave an otoscope on myunit...or
goodbatts #ivchat chemosabe
@IVchatT1 The beamof otoscope lightilluminatethe tissuesof
the arms of younginfant...onlyuseful ininfantsthenmaybe...
#ivchat chemosabe
Yes,accdg to thatarticle RT @nurseeducator:T1 Neverused
one eitherforfindingveinseither! Thinkinglightmighthelp
#IVchat IVchat
RT @IVchat: T1 - its interestingbutfoundthisarticle onother
usesof otoscope..http://bit.ly/gTTP3i #IVchat IVchat
@chemosabe perhaps,accdgto thatarticle.I deal w/adults
mainly#IVchat InfusionNurse
@InfusionNurse perhaps,accdgto thatarticle.I deal w/adults
mainly...likewise #ivchat chemosabe
T1 I diduse a foot operatedX-rayviewinglightonce-samething
I guess.:) Will try itnexttime I'mgraspingfor straws-otoscope
#IVchat nursingpins
T1 I'm concernedoff label use of otoscope here whenthere r
approveddevicestofindveins..any1use those?#IVchat InfusionNurse
T1 paedsandinfstendto have a more translucenttissue that
wouldbe more suitedtouse of lightfor venousoutlining...
#ivchat chemosabe
@nursingpinstolightupthe veins...yes,maybe..#IVchat IVchat
@InfusionNurse bardinOzpromote or sell small ussdevices
#ivchat chemosabe
goodpoint!T @chemosabe:T1 paedsand infs tendmore
translucenttissue thatwouldbe more suited2use of light4
venousoutlining#IVchat IVchat
T1 - have notseenone of those footoperatedlightsinyears -
will have tosettle forthe otoscope.#IVchat nursingpins

4. @chemosabe Isthat usedtofindveinsforPICCinsertionor
peripheral IV insertion?#IVchat InfusionNurse
PlanB otoscope RT @nursingpins:T1- have not seen1 of those
footoperatedlightsinyears - will have tosettle forthe
otoscope.#IVchat IVchat
@InfusionNurse promotedforPICCandMidline insertion,but
do notsee y wouldnotbe suitable forexppractitionerwith
PIVC#ivchat chemosabe
T1 - Was goingto ask - any newtipsfor PICClinesthatflushw/o
resistance butwill notdraw - many more PICClinesusednow.
#IVchat nursingpins
@nursingpinsasinnobld return?#IVchat InfusionNurse
@chemosabe manyUS device rnot forPIV insertions,there r
devicesavail here inthe Stated4PIV use.#IVchat IVchat
T1 Yes- many nursesdrawingfromthemnow - seemslike alg#
quitdrawing?#IVchat nursingpins
@IVchatsure there are downhere too...costis the issue...
#ivchat chemosabe
@nursingpins..thenthere'saprobw/ the line,maybfibrin
buidlup..mightneedtouse cathflo..#IVchat InfusionNurse
@chemosabe Sotrue,cost of those devicesisaconcern,
perhapshard tojustifyforPIV only#IVchat IVchat
T1 some hospshave a policyfortpa (PICC) lines - some don't-
nursesare takinga riskw/opolicy.#IVchat nursingpins
@IVchatpreciselyyhave notinvestedinanytothispointin
time...particularlywenourmedimagingdepartwill dothem4
us...#ivchat chemosabe
@nursingpins...all PICC/central linesshldhave ablood
return..#ivchat VascularAccess

5. @nursingpins..needanorderforcathflo - itis approvedfor
clearinglines(nottpa) #IVchat InfusionNurse
T2 - manyPICClineswill notdrawblood?still flushw/o
resistance?#IVchat nursingpins
RT @VascularAccess:@nursingpins...all PICC/central linesshld
have a bloodreturn..#ivchat#IVchat IVchat
Nexttopiccomingup...#IVchat IVchat
@chemosabe nice thatu have that service,manyhosphere
dontso nurseshave to be creative #IVchat IVchat
we tendto go venogramor portogram to see whatpatencyor
alterationof flowisif noflashingbackor bleeding.#ivchat chemosabe
@IVchatyeswe are fortunate,butstill apainin a$$.. #ivchat chemosabe
RT @nursingpins:T2- many PICClineswill notdraw blood?still
flushw/oresistance?#IVchat IVchat
nice RT @chemosabe:we tendtogo venogramor portogramto
see whatpatencyor alterationof flowif noflashingbackor
bleeding.#IVchat InfusionNurse
maybrevisithowitiscared 4..RT @nursingpins:T2- many PICC
lineswill notdrawblood?still flushw/oresistance?#IVchat InfusionNurse
T3 - wouldhonestlysaythatyou follow the 15sec rule for
scrubbinghubsw/alcohol?#IVchat IVchat
T3 conjecture downhere thatdue to thisissue betteroff notto
scrub hubsat all!?!?#ivchat chemosabe
T3 - I mustadmitI do...:) #IVchat InfusionNurse
T2 thanx for thistopicVernon,apartfromCathflo,whichneed
to clarifyforozzie,wasthere anyothertips?#ivchat chemosabe

6. 15 secondsisrule for handwashing... withalcohol,isn'tonly
until dry?#IVchat swan5675
T3 Centline care isnot consistenthere - one of the many things
we needstandardpolicyfor.#IVchat nursingpins
ReallynoscrubbingjustaccessRT@chemosabe:T3 conjecture
downhere that due to this issue betteroff nottoscrub hubsat
all!?!?#IVchat IVchat
T3 personally,waitforglistentogooff hub/injectionport/bung
whateverwe call it#ivchat chemosabe
So sorry!familyoverfora quickvisit#ivchat NurseEducator
@IVchatnot so muchwith piccs and portsbut withIMI
injectionsandPIVCbungsyes...notinpolicyanywhere
though...?#ivchat chemosabe
RT @chemosabe:T3 personally,waitforglistentogooff
hub/injectionport/bungwhateverwe call it#IVchat InfusionNurse
DefinitelyRT@nursingpins:T3Centline care isnot consistent
here - one of the many thingswe needstandardpolicyfor.
#IVchat InfusionNurse
Also4 hubs RT @swan5675: 15 secondsisrule for
handwashing...withalcohol,isntonlyuntil dry?#IVchat InfusionNurse
@nurseeducatornoprob,welcome back!#IVchat InfusionNurse
T3 - a concernfor CR BSI..#IVchat IVchat
We have IV teamat ourhospital toensure consistencywith
central line care.Onchemofloorwe doour own.#IVChat JoyceHarrellRN
@nursingpins,,there are standardsof practice youcan use as
reference.egINSstandardof practice forinfusionnursing
#IVchat IVchat

7. T3 - @chemosabe,soif notscrubbingat all,what'sur infection
rate?#IVchat InfusionNurse
RT @joyceharrellrn:We have IV teamat ourhospital toensure
consistencywithcentral linecare.Onchemofloorwe doour
own.#IVchat IVchat
We have to obtaindye studybefore usingif nobloodreturn.
#IVChat JoyceHarrellRN
@InfusionNurse ahhthe beauty/dangerof having aninf control
departthat doesnotmonitorIV site ratesor BSIrates???
#ivchat chemosabe
Good policytohave,wishevery1will dothatRT
@joyceharrellrn:We have toobtaindye studybefore usingif no
bloodreturn.#IVchat InfusionNurse
@joyceharrellrndoufollowsame procedureonCLas the IV
team?#IVchat InfusionNurse
@IVchatThanks - So many of NO proceduresstemfromthe
(Watch one,Doone,Showone) fromThe oldCharityHosp.
#IVchat nursingpins
LOL..RT @chemosabe:ahhthe beauty/dangerof havinganinf
control departthat doesnot monitorIV site ratesor BSI
rates???#IVchat IVchat
RT @InfusionNurse:Goodpolicytohave,wishevery1willdo
that RT: We have to obtaindye studybefore usingif noblood
return.#IVChat JoyceHarrellRN
@InfusionNurse @joyceharrellrnone hospinBrisbane has
nurse ledPICCteam,and have done since the earlynineties...
#ivchat chemosabe
RT @InfusionNurse:@joyceharrellrndoufollow same
procedure onCL as the IV team?Yes,usingthe hosp.policies.
#IVChat JoyceHarrellRN
RT @chemosabe:@InfusionNurse@joyceharrellrnone hospin
Brisbane hasnurse ledPICCteam,and have done since the
earlynineties.#IVChat JoyceHarrellRN

8. I'm an oncologynurse,sowe mostlydeal withPicc's andPort's
on our unit.#IVChat JoyceHarrellRN
Impressive RT@chemosabe:@joyceharrellrnone hospin
Brisbane hasnurse ledPICCteam,and have done since the
earlynineties...#IVchat InfusionNurse
T3 - back to hubscrubbing,dou thinknew deviceslike alcohol
impregnatedconnectors(swabcaps) will helpwithCRBSI
prevention?#IVchat IVchat
anotherusesthe OncologyNursestodoall PICC andPort care...
#ivchat chemosabe
@nursingpinsgoodtime toshowthemthe "evidence"or
standards!!LOL #IVchat IVchat
T3 - back to hubscrubbing,dou thinknew deviceslike alcohol
impregnatedconnectors(swabcaps) will helpwithCRBSI
prevention?#IVChat JoyceHarrellRN
RT @chemosabe:anotherusesthe OncologyNursestodoall
PICCand Port care...Good Idea... #IVChat JoyceHarrellRN
Yes ONSjustreleasedthe AccessDevice GuidelinesRT
@chemosabe:anotherusesthe OncologyNursestodoall PICC
and Portcare... #IVchat InfusionNurse
RT @InfusionNurse:YesONSjustreleasedthe AccessDevice
GuidelinesRT@chemosabe:anotherusesthe OncologyNurses
#IVchat IVchat
@IVchatYou are right- #IVchat nursingpins
T3 beststickto the standardsand infectioncontrol policies...
are injectionsites/hubs/bungsroutinelychangedupthere?
#ivchat chemosabe
I came ina little late.We don'tuse the impregnated
connectors.#IVChat JoyceHarrellRN
T3 - here'sinfoonswabcapshttp://bit.ly/eoEbKT(notan
endorsement) there rothers#IVchat IVchat

9. @chemosabe.We have policiesonwhentochange needles,
drsg changes,hubs.#IVChat JoyceHarrellRN
@chemosabe Changedq7 days here (withbio-patch) butagain
not standard.#IVchat nursingpins
Yes RT @chemosabe:T3 are injectionsites/hubs/bungs
routinelychangedupthere?#IVchat InfusionNurse
RT @IVchat: T3 - heresinfoonswabcapshttp://bit.ly/eoEbKT
(notan endorsement) there rothers(Thankyou) #IVChat JoyceHarrellRN
RT @IVchat: T3 - heresinfoonswabcapshttp://bit.ly/eoEbKT
(notan endorsement) there rothers#IVchat InfusionNurse
We change port needlesq6 days,caps aftereveryblooddraw,
or every3 days if no blooddraw.#IVChat JoyceHarrellRN
RT @joyceharrellrn:We change portneedlesq6 days,caps
aftereveryblooddraw,or every3 daysif no blooddraw.
#IVchat InfusionNurse
@joyceharrellrn6daysnot 7days?justcuriousmost r 7 days
#IVchat IVchat
Dont u downthere?RT @chemosabe:T3are injection
sites/hubs/bungsroutinelychangedupthere?#IVchat IVchat
T3 justreferredtolocpol...swabbedwithalco andallowedto
dry...bungschangedpermanufacturersguidelines...copout...
#ivchat chemosabe
We doit 6 days.I thinkitwas originallyforkeepingaflow.
Tubingchange on CL were every3 days.So,everythingisinsync
#IVChat JoyceHarrellRN
RT @chemosabe:T3 justreferredtoloc pol...swabbedw/alco,
allowedtodry,bungschangedpermanufacturersguidelines,
cop out #IVchat InfusionNurse
Heythere @nursingpins...Funtopic.#IVChat JoyceHarrellRN
@IVchatDont u downthere?anecdotallysome hospsinbris
not changingbungsroutinelyonPICCs#ivchat chemosabe
T3 @joyceharrellrnlike the ideaof 6 daysfor sync butsystem-
wide we are 7 days#ivchat NurseEducator
Wow,we're almostat an hour,wantedto wrap upa bitearlyto
allowtime to switchto #MDchat. Any partingthoughts?#IVchat IVchat

10. Yes,do u insertPIVsbevel uporbevel down...LOL..justcurious!
#IVchat InfusionNurse
@joyceharrellrnHi - listening- :) andlearning.#IVchat nursingpins
nothingmore to add,but,thanks,exactlysortof discussionsi
was anticipating,thanksall #ivchat chemosabe
@InfusionNurse bevupof course...doesn'teveryone...?#ivchat chemosabe
@nurseeducatorItmakesitflow nice.Daythree tubingand
caps change,day six,tubing,caps,needle.drsg,(unlessblood
draws) #IVChat JoyceHarrellRN
it ischangedregularlyperpolicyRT@chemosabe:Dontudown
there?anecdotallysome hospsinbrisnotchangingbungs
routinelyPICCs#IVchat InfusionNurse
RT @nursingpins:@joyceharrellrnHi - listening- :) and learning.
Alwaysfuntolearn.#IVChat JoyceHarrellRN
@InfusionNurse afewdownugh...so traumatic...surprised
theyare successful?#ivchat chemosabe
RT @InfusionNurse: Mostlysaidup,afew downRT
@chemosabe:@InfusionNurse bevupof course..(Bevupfor
me alwaysfor anyneedle) #IVChat JoyceHarrellRN
It's a wrap, thankyouso much everyone forjoiningtonight.It
has beenfunandinteresting!!Goodnite all!!#IVchat IVchat
Had neverheardof bevel down?thoughtImissedsomething.-
#IVchat nursingpins
goodmorningall.goodsleep#ivchat chemosabe
ThanksCora and all present.#IVchat nursingpins
Thanks,sorry I got onlate.#IVChat JoyceHarrellRN
Yes,a fewsaid downRT @nursingpins:Hadneverheardof
bevel down?thoughtImissedsomething.- #IVchat InfusionNurse
Good night!Missedmostof a good chat! #ivchat NurseEducator
ThanksGlennRT @chemosabe:goodmorningall.goodsleep
#IVchat IVchat
NextIV chat will be Dec.8 Wed 8PM! #IVchat IVchat

11. RT @chemosabe:goodmorningall.goodsleep(mydaysand
nightsare alwaysmessedup.Oncnurse bynight,wellnesscoach
by day..:) ) #IVChat JoyceHarrellRN
We missedutoo,but summarywill be upina few RT
@nurseeducator:Goodnight!Missedmostof a good chat!
#IVchat IVchat
Thankseveryone forjoining,thiswassofun!!Love that Glen
couldjoinusfrom downunder.Till nextchat.#IVchat InfusionNurse
will putitin mydiary...off to physical meetingnow!#ivchat chemosabe
@joyceharrellrn@chemosabe @nursingpins@nurseeducator
thankshave a wonderful week.HappyThanksgivingtothose in
the states.#IVchat InfusionNurse
@InfusionNurse@chemosabe@nursingpins@nurseeducator
thankshave a wonderful week.HappyThanksgivingtothose in
the states.#IVChat JoyceHarrellRN
IV flusheswithsaline>IV flusheswithheparin.#ebp#IVchat
#whatILearned Marcia_Lynn23
RT @joyceharrellrn:@InfusionNurse@chemosabe
@nursingpinsthankshave awonderful week.Happy
Thanksgivingtothose inthe states.#ivchat NurseEducator
If u all have time,gooverto #MDchat now in progress#IVchat IVchat
see mybloghttp://is.gd/hFPBsRT@nursingpins:Hadnever
heardof bevel down?thoughtImissedsomething.- #IVchat InfusionNurse
Saline preferredRT@Marcia_Lynn23: IV flusheswithsaline>IV
flusheswithheparin.#ebp#IVchat#whatILearned#IVchat InfusionNurse
Thanks,have a great day!!RT @chemosabe: willputitinmy
diary...off tophysical meetingnow!#IVchat IVchat
RT @IVchat: NextIV chat will be Dec.8 Wed8PM! #IVchat IVchat
Sad I missed#IVchattoday!HopefullyI'll catchthe nextone. jennparsonage

12. @swan5675 ..oops,sorryjustsaw ur tweet,use tweetchat.com
nexttime andenter#IVchat.www.ivchat.orghasthe
summariesof pastchats. IVchat
@nursinglink - Iknowitspast 5 ur time butthanksfor joining
#IVchat. IVchat
@IVchatjust sawthispost.I apparentlymissedit.#IVchat bthenextstep
justtesting........#IVchat swan5675
kewl!Iknowhowto do this,now.Thanks!Amlookingforward
to the nextchat (Whenisit?) #IVchat swan5675
I see nextchatis December8 (My birthday...easyto
remember.) Itisat8PM....but,inwhat time zone?Ilive in
Indiana.#IVchat swan5675