Hi, my hospital has just switched from the Baxter interlink to the Baxter onelink with extension. I know most hospitals changed from the old interlink system long ago, but we had been happy with it so it took us awhile. Here is my question: Our protocol has always been to change propofol tubing every 12 hours. We did not change the cap when we changed the tubing. I am wondering what is the practice with extensions out there when changing propofol tubing? Do you leave the extension and cap and just change the administration tubing every 12 hours or do you switch out the extension too? Prior to this switch we used extensions but it wasn't a common practice to do so on every patient. So culturally and procedurally this is a switch for us to have an extension on every line.
Thanks
Some brands of propofol need to have set changed every 6 hours, others every 12 h. I am a strong proponent of extension sets on all PIVCs. I am assuming your are asking about infusion through PIVC. The issue is certain fungal organisms growing in the propofol. Small amounts of propofol left in the housing of stopcocks has been linked to BSI. I would recommend changing the whole infusion system. But then the issue becomes what does manipulation at the PIVC hub do to catheter dwell time and complication rates. And there is no evidence-based answer to that question. If using some new PIVCs (eg Nexivia, Deltaven) the extension set is permanently attached and cannot be changed without removing the catheter. Have you discussed this issue with your infection prevention dept?
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Okay, thanks. Our propofol is an every 12 hour tubing change. Sorry, I didn't specifiy but yes, I am talking about a PIV. Previously, with the old interlinks we changed the tubing q 12 and only changed the interlink cap when we need to restart the line. We have never had fungal infections on our propofol lines in the past and we definately do not want to do anything that would change that. For infection control reasons we feel we should either change the extension or not place an extension on the catheter at all. We have concerns about taking all the tubing and extension down to the hub every time we change the tubing because, even briefly, the exposed hub open to air could also lead to infection, the manipulation of the catheter that close to the hub could cause problems when unscrewed q 12 as you point out, and lastly because a vein with a very robust blood return can be difficult at times to tamp off during the change and leads to an increased risk of blood exposure to the ICU nurses when they change everything. I can check with infection control and see what they think but this type of question often gets fielded to us in IV therapy by them. I was wondering what the practice was at other facilities. Thanks again for your input.
Agree with all except opening the hub and exposure to air as a risk. No evidence of that, but manipulation can easily lead to touch contamination. Good luck.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi-This is my first post. I recently retired from BD and specialized in the needleless connector product line for the past 14 years. I have supported all connector designs. Kuddos to you for posing this question early on in your product change because it is a really good question! It can have a significant impact on workflow, clinical outcomes and ultimately costs in the optimal maintenance of lines.
With respect to aministration set changes, INS verbiage is to change tubing and "all add on pieces" which may included.....(ext sets, filters, needleless connnector). Keep 3 things in mind, INS is not product specific, products differ significantly and they encourage you to look to your manufacturer for specific information. Your situation is classic because you are not only adding the ext set (NC could be removable or bonded on) but are also going from a fluid filled design (Interlink) in which the external cannula (alligator clamp) can be changed independent of the connector change to a connector that elimintes the add-on cannula becasue it is now integrated in the luer lock needle-free connector. Questions related to Needleless connectors are complex and there are 5 different line maintenance protocols that can be affected with a simple product change.
Ask for invitro Microbial testing of your new connector. This will help you to understand the connector design telative to internal contamination. With this information in hand, you can determine what your disinfection and change out policies and practices should be when integrating that specific product in to your line maintenace bundle.
Hope this helps.
Chonna
Thank you Chonna.