Our IV dept. changes the connectors on our central lines every 7 days with the dressing change (part of a sterile procedure). With the CMS changes, we are considering having these connectors changed with the tubing. This task would fall on the floor RNs. Do you consider this a sterile procedure requiring sterile gloves and drape or a clean procedure utilizing non-sterile gloves, not letting the hub fall?
It is a clean, no-touch procedure. CDC recommends changing these at the same interval as the tubing changes. If you are using these connectors in the line with continuous infusion, I recommend eliminating them. They are not needed, add costs, add another junction that must be secured, and add the risk of contamination if they become loose. The only benefit I have ever heard is that they make it easy to change tubing without opening the line completely. If you go by the CDC recommendations and change these connectors at the same time as the tubing, then having these in the line is no longer a benefit. Their primary purpose has always been for intermittent infusion. CDC does not make a difference between tubing uses, however they do state to access a needleless connector only with a sterile device. There is absolutely no way that an intermittent tubing remains sterile for 72 to 96 hours and there are no studies that have evaluated this. So change the needleless connector every 72 to 96 hours but change intermittent tubing every 24 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
Lynn
Our CVAD policy states to always place a leurlok cap on the hub and not to connect the tubing directly to the hub---for safety reasons, incase the tubing should become disconnected and the port is unclamped. What is your thinking on this?
Deb
I think it could add unnecessary risk. It creates a second connection site that can also come loose and can become loaded with blood, drug precipitate, etc. It also makes it far too easy for primary care nurses to frequently disconnect continuous IV infusions for any reason - ambulation, eating, showers, etc. This should never be done in my opinion. Those fluids are intended to meet a therapeutic goal. When they are frequently disconnected, those goals are not met. Also how is that tubing being managed while disconnected? What is your written protocol for reconnecting those lines? With the risk of bloodstream infections now associated with some types of mechanical valves, I do not think it is wise to have these in a continuous line.
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
The NICU practice is quite different (from my understanding..I am not a NICU nurse). They do use sterile technique and wear masks during cap replacement. They are really protective of their lines and are really doing everything to prevent complications like BSI.
Does that sound right, NICU nurses?
Gwen Irwin
Austin, Texas