I would like to know if there is evidenced based practice to support what is best practice. When infusing TPN is it best to use a needleless connector on the hub of the central line lumen or connect the tubing directly to the hub. If a connector is used, do you change it daily. Thanks
In my opinion, there is NEVER a need for a needleless connector when there are continuous fluids of any kind infusing. I realize that home care patients receiving cyclic TPN is different. I am talking about hospitalized patients receiving continuous infusion of any fluid. The presence of a needleless connector adds a second luer lock with the risk of possible disconnection. It makes it excessively easy to disconenct for the least reason, encouraging nurses to frequently stop infusion and disconnect. Add the evidence about biofilm growing in needleless connectors and I do not believe they should be used for any continuous infusion, TPN included. There have been no studies on this specific issue though. Needleless connectors were designed for intermittent infusion and should be used for that purpose only. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In my opinion, there should be a needleless connector attached to each lumen of the catheter. The statement "The presence of a needleless connector adds a second luer lock with the risk of possible disconnection" is very misleading. The risk of luer disconnection is the same regardless of the number of connectors. Additionally, the consequences associated with luer disconnection at the lumen are far more serious when there is no connector versus one with a connector. Risks include air embolus, contamination/infection, bleeding, etc. A disconnection may go unnoticed until the linens become saturated with fluid and/or blood or the patient complains of feeling something wet. By then, the damage is done. If a connector is on the lumen, one could just perform a scrub the hub and cap/tubing change.
At our facility, we consider the access cap or connector as part of the TPN tubing and therefore should be changed on the same schedule as the TPN tubing change.
I disagree that my statement is misleading. Two luer locked connections have double the chance of one becoming loosened or disconnected as opposed to having only one luer lock connection. If the connection that comes loose is the needleless connector, you have the same risk of air embolus, bleeding, etc. Each hospital must establish their own policy and each of our statements is only based on our individual professional opinion at this point as their is no evidence to support either one. When changing an IV set with or without a needleless connector, you have a chance of air entering the lumen and must use the same precautions regardless of whether the connector is present or not. Due to the risk of BSI associated with these devices, I would choose not to allow them for any continuous infusion in a hospitalized patient. I do realize that cyclic TPN in a home care patient is different and I would consider this to be an intermittent infusion rather than continuous. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In a home care setting we use needless connectors no matter the circumstance. They are to be changed every 3-4 days or if blood draw is completed.
Janelle Wilkens, RN, BSN
Home Infusion Therapy Nurse
Pediatric Home Service
In a home care setting we use needless connectors no matter the circumstance. They are to be changed every 3-4 days or if blood draw is completed.
Janelle Wilkens, RN, BSN
Home Infusion Therapy Nurse
Pediatric Home Service
I would like to see if this practice is coming more frequent with chronic long term pediatric (specifically short gut) patients on cyclic TPN at home for other homecare agencies. Recently in our area our parents have been instructed by the MDs/NPs ordering their therapy to change the needless connector DAILY before hooking up the TPN. The reasoning is this group of pts increased incidence of CRBSIs and is just one change in practice to help reduce this incidence. As you can imagine the pharmacy suppliers are not pleased and I can not find any studies or evidence to support this practice. I have been caught in the middle and of course have to follow orders.