The current 2021 INS Standards (36) discuss to change the needleless connectors no more frequently than 96-hour intervals or according to the manufacturers' directions for use. It goes on to state "when used with a continuous infusion system, the needleless connector is changed when the primary administration set is changed (eg. 96 hours). One study reported that changing the needleless connector every 24 hours with blood or lipid infusion increased CABSI rates in pediatric stem cell transplant patients".
I am currently working on policies at the hospital and the question came up about needleless connector changes with parenteral nutrition. we change the administration set for PN every 24 hours - the question raised is do we change it every 24 hours with the adminstration set change? It seems conflicting in the standard and I was looking for clarification to make the best recommendation for the policy.
Ideally, the use of the needleless connector wouldn't be used with a continuous infusion, but this practice is sparatic at best.
Any guidance would be greatly appreciated.
Thank you
What you are reading is the best standard that could be written based on the evidence available. IMO, a needleless connector is not appropriate to be used in any continuous infusion. It adds an unncessary connection and allows for much too easy disconnection for ambulation etc. Any and all manipulation of the system adds risk for infection. So no needleless connector for PN would be the policy and procedure I would establish and hold all accountable to this policy. If you insist on using a connector, you can do several things. First do a literature search from early 2020 forward to see if there are any new studies. Second, take this to your practice committee so they can assess the risk and what your policy should be. Third, pull the references listed for these statements in the SOP and read them to assess how or if they are applicable to your facillity. There are many times when studies do not address every single aspect of practice and this is one of these times.
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