I was presented with a situation today that I did not know the anser to and I call on my vascular access friends here on the list serve.
On intermittent tubing (antibiotic) I know that it need schanged every 24 hours. I assume that that means when a needle or needleless device is luerlocked on the end of the intermittent tubing that the needleless device should be changed with EACH antibiotic hung.Â
The question is.... what happens when that intermittent tubing DOES NOT have a needle or needleless device on the end of it, this would be so that the intermittent tubing gets directly accessed into the saline lock or primary tubing. How often does it need changed? My thought is that every 24 hours may not be enough, because the tip of the tubing has then gone in and out of the primary line or saline lock, 3 or 4 times during the course of the day, every time the med is given.
Hope this makes sense.
Mary Ann's description follows the INS standards of practice exactly. Cheryl, see Standard 48, II Practice Criteria C & D. You can either use a blunt cannula or a sterile tip cap, placing a new one on the end of the tubing after the infusion is complete. The challenge is having those cannulas or caps readily available at the bedside in all settings. Tip caps are cheap, easily obtained and come in a variety of colors. It is imperative though that proper attention be paid to maintaining this tubing in an aseptic manner between doses. Policies should also be very clear about discarding the tubing if blood has back up into it or if it is compromised in any way. We have put a lot of emphasis on the infection risk associated with needleless connectors but no one is really looking at the tubing that is being attached to these connectors. When these tubings are managed in such a careless manner, we can not blame the needleless connector for the resulting infection!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Cheryl Kelley RN BSN, VA-BC
Robbin George RN VA-BC
You make a very good point. I think this is based on an "assumption" that nurses can maintain the male luer tip of the tubing in an aseptic manner. This may have been true when we were placing a needle on the end of this tubing and it may be true today with a blunt cannula covering the male tip. But now that we are connecting a bare, open male end directly to the mechanical valve needleless connector, who is to say that this can be maintained in an "aseptic" manner? As I have mentioned, published, and regularly teach, there is not one data point ever published on the use of intermittent tubing. All tubing studies have been conducted on continuous tubing. So we really do not know what is on the ends of all that intermittent tubing. I shudder to think what is happening on those sets that are used for 72 or 96 hours!!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Robbin George RN VA-BC
Well, it may or may not be. There are no studies on doing this so we just can't say. There is one study on improper use of multidose vials leading to bloodstream infection that states there can be 1 million RBCs in solution without a color change. So there can be blood contaminating the fluid in the tubing tip without ever seeing that blood is there. So cleaning may not have any affect on this. Also, some alcohol pads are labeled as sterile and some are not. What are you actually cleaning this tip with? Lots of questions but very few answers yet.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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