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Leigh Ann Bowegeddes
Standards for changing needleless connectors

We are in the process of revising our policies. Our current policy regarding changing of needleless connectors states that they will be changed every 7 days and after blood draws. I know many are changing their connectors every 72 hours and after blood draws. Can anyone cite specific published literature to help support our decision on this? Also, our products committee will not support the connector change after blood draws, and I have just been told that staff are removing the connector, drawing blood, then reapplying the same connector, after reportedly laying the old connector on a sterile field. I disagree with this practice, but need some support to affect change. The argument is that the connectors are too expensive to be changed with blood draws, and some patients are having blood drawn every few hours.

Leigh Ann Bowe-Geddes, BS, RN, CRNi

University of Louisville Hospital

lynncrni
2002 CDC guidelines states

2002 CDC guidelines states that needleless connectors should be changed at the same interval as your IV sets. That would be either 72 or 96 hours. Some companies test out to 7 days and then others test to a certain number of actuations, but there would be no easy way to track the number of times a connector is entered in clinical practice. 

I have never seen any studies or guidelines calling for changing the connector with each blood draw, although that is common practice. I think this got started because most of them are not clear and the nurse is not sure if they have flushed all blood from them. I strongly agree with you about the practice you describe. Once a connector has been removed, it should never be reapplied. You might find statements to that effect in the instructions for use. Either the sample should be drawn through the connector and then replace it with a new one or remove the old one, draw direct from the hub and  then put on a new one. I can understand the concern for cost for inpatients with the frequency of blood draws. This get back to the discussion about stopping the routine practice of using a catheter for obtaining blood samples. This is hub manipulation that increases the risk of contamination and BSI. No easy answer on this one. 

 

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

Leigh Ann Bowegeddes
Thanks, Lynn. I knew you

Thanks, Lynn. I knew you would agree with me that reapplication of a used connector is unacceptable, and I appreciate your response.

As an aside - I have noted that some of the clear connectors trap blood that you cannot flush out with one flush. Some of the reps for one of these connectors are suggesting connecting, flushing with half your flush solution, disconnecting, then immediately reconnecting with the same syringe, and continuing the flush. This activates the mechanism in the valve, and the motion helps to get the blood out. The reps don't understand when we try to explain that a flush syringe is for a single connection only, this would be bad practice, and the inservicing for it would be overwhelming. Fortunately, we do not use that particular clear connector, but we still think these reps must stop teaching this practice.

Leigh Ann

lynncrni
Again, I wholeheartedly

Again, I wholeheartedly agree with you. Flush syringes are for single dose, single use, single connection. So any of you that are reading this, I beg you to stop promoting practices that are below the national standard. 

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

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