The INS standard states that "The nurse should aspirate for a positive blood return from the vascular access device to confirm device patency prior to administration of parenteral medications and solutions." I agree that this is a very important step. My questions are: Do you aspirate every time if you are administering a medication more than daily? And, if you do aspirate and get blood in the needleless connector do you change the needleless connector every time? We are a pediatric home infusion company and so most of our medications administered in the home are given by a trained family member/caregiver. We do not teach them to aspirate prior to med administration. But, occasionally, a child will have an extended hours nurse in the home who gives the med and we have found that they are aspirating with each dose given ( every 4 hrs, for example) and not changing the needleless connector.
Yes, I would aspirate with each dose of medication in an acute care setting. However most home care does not teach patients to do this aspiration with each dose. There are concerns about technique and the correct evaluation of the quality of the blood return obtained. So home care nurses will do this aspiration and evaluation with each nursing visit to change the dressing, etc. Of course, the patient and your other nurses must know how to evaluate all of the signs and symptoms of all catheter complications. The positive blood return is a huge piece of this catheter functionality assessment. But there are not any home care studies to answer this question. In my opinion, the extended hours nurse would practice under the same national standards as any other nurse and also your policies and procedures. So whatever is done by the home care nurse should be done by the extended hours nurse as well.
Regarding aspiration into the needleless connector and its change, there is also no studies about this either. Does the presence of blood for this short period of time increase the incidence of CRBSI? No one knows. We do know that mechanical valve needleless connectors have a greater risk of intraluminal contamination than split septum needleless connectors, but all NCs can grow biofilm. This biofilm reaches a steady state in about 5 days. So all NCs should be changed at least every 96 hours to prevent the growth of biofilm to its complete steady state. This is the point where the biofilm growth is equal to the breakage and floating into the bloodstream. For the NC, I would focus on the thorough scubbing of all surfaces of the NC with each and every connection. SASH = 4 connections so this means 4 times to scrub for 15 seconds with a new alcohol pad each and every time. I would not change the needleless connector simply because there has been blood aspirated into it and then immediately flushed out. The only studies about this have looked at the accuracy of blood cultures drawn through used NCs and found that the NC should be changed before the culture is drawn.
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
Thank you for your response, Lynn. You validated my thoughts arounds this. Pat