There was a great poster last week at LITE on reflux. Jefferson Hospital IV TEam (Patty Luptak).
I never thought about this but the needle-less systems in the IV tubing like the Alaris (smartsite they showed Alaris) and Baxter (clearlink) causes reflux at the connection point. If one piggybacks into the system and than disconnects when the pin pops back up from the piggyback site reflux occurs in the catheter valved or non valved. Great poster on their part. They should take it to INS and AVA. Addition of a positive pressure system and postive pressure flush was crucial to getting rid of reflux. It just goes to show when piggybacking into a tubing you need to do a positive pressure flush after disconnecting the piggyback bag. Greast poster on behalf of a team looking at occlusions and reflux. You now have to look at tubing and flushing to reduce reflux and occlusion.
As far as valved catheters having slower blood draws. It is true. Groshong, PasV and solo all have that issue as well as if you draw from a valved needle-less system. It does slow the pull back versus an un-obstructed open line. My suggestion is to realize that when doing a blood draw or use a smaller syriunge for blood draw to reduce withdrawal pressure. Law of physics is large syringe reduces pressure when pushing forward but a small syringe reduces pressure when withdrawing and a large syringe on withdrawal causes more pressure. 5 CC syringe on withdrawal will reduce pressure
But Kathy, secondary medications piggybacked into a primary continuous infusion set should not be disconnected. That set should remain connected so that all sets can be changed together no more frequently than 72 hours. If those piggyback sets are disconnected with each dose, they are now considered to be an intermittent set and should be changed every 24 hours.
Kathy - would you be able to help me connect with Patty to get a copy of the poster for educational purposes? I think this might be one convincing part of the argument not to disconnect, among other things.
Mari Cordes, BS RN
Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Kathy Kokotis
Bard Access Systems
There was a great poster last week at LITE on reflux. Jefferson Hospital IV TEam (Patty Luptak).
I never thought about this but the needle-less systems in the IV tubing like the Alaris (smartsite they showed Alaris) and Baxter (clearlink) causes reflux at the connection point. If one piggybacks into the system and than disconnects when the pin pops back up from the piggyback site reflux occurs in the catheter valved or non valved. Great poster on their part. They should take it to INS and AVA. Addition of a positive pressure system and postive pressure flush was crucial to getting rid of reflux. It just goes to show when piggybacking into a tubing you need to do a positive pressure flush after disconnecting the piggyback bag. Greast poster on behalf of a team looking at occlusions and reflux. You now have to look at tubing and flushing to reduce reflux and occlusion.
As far as valved catheters having slower blood draws. It is true. Groshong, PasV and solo all have that issue as well as if you draw from a valved needle-less system. It does slow the pull back versus an un-obstructed open line. My suggestion is to realize that when doing a blood draw or use a smaller syriunge for blood draw to reduce withdrawal pressure. Law of physics is large syringe reduces pressure when pushing forward but a small syringe reduces pressure when withdrawing and a large syringe on withdrawal causes more pressure. 5 CC syringe on withdrawal will reduce pressure
Kathy - Bard
Kathy Kokotis
Bard Access Systems
But Kathy, secondary medications piggybacked into a primary continuous infusion set should not be disconnected. That set should remain connected so that all sets can be changed together no more frequently than 72 hours. If those piggyback sets are disconnected with each dose, they are now considered to be an intermittent set and should be changed every 24 hours.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Kathy - would you be able to help me connect with Patty to get a copy of the poster for educational purposes? I think this might be one convincing part of the argument not to disconnect, among other things.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Pages