1. Our current policy is to change adapters on heplocked lines weekly unless lipids or blood is transfused through them. So, if TPN is administered intermittently, the tubing would be changed at 24 hours and the adapter would be changed weekly which was based on a category II CDC guideline that states “change needleless connectors no more frequently than every 72 hours or according to manufacturers’ recommendations for the purpose of reducing infection rates.”
2. How do you define heplocked lines? When should the adapter be changed on a “heplocked line”? Do you recommend changing the adapter with each intermittent infusion regardless of product (i.e. lipids or TPN)?
The term "heplocked" is a shortened version of "heparin locked". Catheter locking is defined in the 2011 INS standards of practice. You are establishing a column of fluid inside the catheter lumen in an effort to prevent blood from refluxing into the lumen and causing occlusion. For all CVADs, heparin is the preferred locking solution - see INS standard of Flushing and Locking. For all short peripheral catheters, the preferred lock solution is normal saline - also in the Flushing and Locking standardd. Therefore heplocked would apply only to a CVAD. Research has not completely established the most appropriate time for changing any needleless connector. Your statement from 2011 CDC is as close as we can come right now. Any IV administration set used on an intermittent basis means that it is manipulated on both ends frequently and should no be used longer than 24 hours. CDC now says this is an unresolved issue. This is because there is no published studies with data on intermittently used IV sets. INS has always said intermittent sets must be changed at 24 hours, which is the original length of time that a set could be used. So change the IV set for your TPN patients every 24 hours. If you are infusing cyclic TPN, I would discard the set each morning when the infusion is complete and get a new set that night when a new infusion is begun. For these patients, I would prefer to change the needleless connections every 72 hours because we do have evidence that biofilm grows inside these devices. If you are using a needleless connector on a continous infusion (which I do not think is necessary), you would be changing the IV set at least every 96 hours but you could go out as far as 7 days according to 2011 CDC. In this case, the needleless connector would be changed at the same time as the IV set. I recommend that the IV set be connected directly to the catheter hub without a needleless connector for continous infusions though. Lynn
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