We currently have a new owner of our facility and they are questioning the frequency of needleless connector changes on central lines. In the past we have always changed them with any blood draws and weekly with dressing changes. Policy at their other facilities is changing them every 72 hours and changing all IV tubing at that time. What is the current INS recommendations on frequency for connectors/tubing?
Please read all details in the INS SOP on Needleless Connectors. If using them in a continuous infusion system (which I oppose by the way), they should be changed when the admin set is changed, usually no more frequently than 96 h. If using them for intermittent infusion, which is what they were designed for, the SOP says no more frequently than 96 h. So you could change weekly with dressing changes on intermittent use. There are more criteria listed in that SOP for when to change but the only reason to change with a blood sampling procedure is when you are drawing blood cultures from a CVAD and then the NC should be changed BEFORE drawing the sample. Read full details in the SOP.
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
Hi Lynn I appreciate your response above regarding when to change the needleless connector.
My question to you is, why is it okay to change the intermittent tubing lumen's connector with the dressing change (which would only be once a week) and change the continuous tubing lumen's connector every 96 hours, when there is less manipulation to the connector in the continuous tubing situation??? I would think they both should be changed every 96 hours or every 4 days.
We just now changed our policy on tubing change to every 4 days with continous tubing as per the 2016 INS SOP, but are struggling with when to change the connectors for both types of tubing.
We left the intermittent tubing daily and no longer are asking for the connector to be changed with that tubing, but are stuggling with this one.
Please advise,
dee morrisond
I think you have misunderstood something. A needleless connector is attached to the catheter hub and is separate from the IV administration set. So this phrase is confusing - "intermittent tubing lumen's connector". The catheter is used for intermittent infusion with the NC attached to the hub. In this case, the NC is changed no more frequently than 96 h. This means you could go longer and some home care companies choose to change it weekly during the nursing visit.
The administration set for intermittent meds (no continuous infusion) is connected and reconnected with each dose and therefore there is more manipulation of this set on both ends. This should be changed every 24 h.
For continuous infusions, the set is changed every 96 h for crystalloid fluids. IF you place a NC on the catheter hub for continuous infusion, you should be changing the NC and the continuous administration set at the same time at 96 h. You should not change the continuous administration set and leave the NC as this would require opening the system to change the NC at a latter time.
The goal is to reduce the number of times that all componnets of the system are manipulated in any way which includes all connection, disconnection, and attachment of syringes.
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
Hi Lynn, I know I totally confused you.
I met to say the difference between when you change the connector when you have continous tubing vs intermittent tubing.
So are you saying if we did the following we would be withing the 2016 standards:
1. change connectors every 96 hours with continous tubing - also change any unused connectors every 96 hours on that patient
and also
2. change connector/s with dressing change ( every 7 days) when there is only intermittent tubing.
Dee
dee morrisond
Yes.
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
Our policies for our nurses in LTC, is that needleless connectors are to be placed on end of all IV catheters. We had a recent case, were a nurses did not follow our P&P, and hooked TPN tubing using the direct connect technique to the IV catheter. When 24 hrs came around and she needed to change the bag and tubing, this sticky solution would NOT LET HER remove the administration set and despite many attempts to remove it, it was permanently affixed. The patient required a new PICC.
I would bet that the person who put that NC onto the catheter hub had cleaned the VAD female hub with alcohol prior to attaching the NC. Alcohol on plastic can make it soft. Hubs do need to be cleaned but they must be dry before anything is attached to the hub. Usually the glucose will break open, although it might be hard but it usually comes apart. But when the alcohol has softened the actual plastic and a new device is attached, the two piece of plastic fuse together.
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