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changing caps after blood draw
Our current policy is to change caps after blood draws from central lines.  There has recently been a lot of discussion as to why this is necessary due to the fact that we use the clc 2000.  The manufacturer states that you do not need to change the cap after a blood draw.  However, their research shows that 2.08% Hemoglobin still remains in the cap after a second 5ml flush.  We flush with 10ml Normal Saline.  I believe this may have an impact on our high occlusions rate (staff are not changing the caps after blood draws as per policy).  We average about 40 occlusions per month.  We hope to trial the MaxPlus cap in the near future with the clear cap.  Can anyone tell me what thei policy is regarding cap changes, including those using positive pressure caps?  I am trying to weigh the risk associated with opening the lines with cap changes multiple times a day to the risk of line occlusion with possilble subsequent line infection.  Input would be appreciated.
Tom Billings
Michelle, The priming volume


The priming volume or deadspace of the CLC2000 is only 0.06cc.  This is the lowest available in positive displacement connectors. The research shows 2.08% hemoglobin after the second 5 cc flush. I see that you appreciate the importance of keeping the hub closed.  Could you increase your flush volume to 15cc?  This may be all the change needed.  Please contact your ICU Medical Rep for further support.  You can find the contact info on the website under about ICU.."Product Specialists".

Hope this helps,


Carole Fuseck
Michelle, we currently

Michelle, we currently change caps every 3 days and use a positive pressure cap from MaxPlus (all-white cap with flat blue center).  This month we are starting a trial (after educating staff) at one site using the new MaxPlus Clear cap and a weekly cap change while doing the dressing change, and completing an assessment.  If we can achieve compliance and keep our infection and occlusion rate down, we will move this to the other two sites.  We flush with 10mL saline after infusions and with 20mL after blood draws and when checking for blood return. 


Nancy Rose RN IV Team VA

Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830

For the five plus years I have been at the VA we have changed our Alaris smartsite caps along with our weekly dressing changes. Complete occlusions have been unusual. We just recently purchased Max Plus Clear caps. Flushes after blood draws and blood transfusions are 20cc of saline. It definitely takes two 10cc (separate flushes) to visibly clear blood from the cap.

When weighing the infection risk of changing caps with blood draws, consider the variety of techniques that may be employed. The nurse who barely wipes an end cap before attaching a syringe shouldn't be changing end caps. At our VA the IV Team changes the caps. Presumably this limits the variations in technique and lowers contamination rates.

Nancy Rose 

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