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 I see that no one has responded to your question yet. I can not tell you what others are actually doing but I can tell you what I recommend and I am confident in these recommendations being evidence-based. 

First, increasing the frequency of change or changing more often does not reduce the risk for needleless connectors (NC). 

Second, removing the NC from all continuous infusions on hospitalized patients is my strong recommendation for many reasons. There is no evidence to support their use in these types of infusions. It adds the risk of 2 luer-locking connections rather than 1. NCs are a known source of infection. They must be changed at the same time as the IV set, so the idea of preventing air emboli goes out the window. 

I would change all NCs every 72 or 96 hours. If your time to change the IV set is 96 h and you are using the NC in this continuous system, you have no choice but to change the NC with the IV set at 96 h. 

For al VADs used for intermittent infusion, the NC can be changed at 72 or 96 h but the intermittent infusion set should be changed at least every 24 h. You might consider making this policy to be the same change frequency as the continuous IV set for consistency. Making one change at 72 and the other at 96 could confuse some staff. 

If drawing blood cultures from a CVAD, you must remove the old NC BEFORE drawing the culture sample because the NC can easily produce a false positive result. 

There is no evidence for changing the NC after each blood draw. 

See INS Standard #27 Needleless Connectors, Practice Criteria F for a list of other clinical conditions that require a change in the NC. 

Lynn

I am so glad you are asking this question!  I am currently finding the documentation of the cap changes by the nurses is not being done, which begs to question, are the caps gettting changed.  I work in a 350 community hospital.  We have a new computer system (2 years old now) that makes documenting tedious and combersome to find things.  Due to a gradual increase in our CLABSI rate over the past year, I was looking at the continuity of care and documentation of the caps.  My thoughts, which we did at another hospital I worked on the Vascular Access Team PRN, was to have the Vascular Access Team change the caps routinely and document with consistency.  Obviously this would not be at the same time as tubing change, but more likely twice a week.  What are your thoughts on this process? 

 I'm having trouble understanding how connectors can both be unnecessary and also need to be changed.  Correct me if I'm wrong, but the reason for changing connectors is that being the point of connection they are potentially subject to contamination and as a result need to be changed.  Without a removable connector, the hub of the lumen is still the point of connection and potentially subject to contamination but the problem is that they can't be changed without removing the entire line.  If the point of connection needs to be changed regularly, why make it so it can't be changed?

 Needleless connectors are considered as add-on devices. The catheter hub is a manufactured part of the VAD itself. Adding on any pieces (eg. NC, filters, ext sets, manifolds, stopcocks, etc) adds the risk of contamination due to hub manipulation. They add additional points of connection which could work loose, leak, and allow for entrance of organisms. Stopcocks, manifolds and NCs are the most notable for this contamination as studies have shown them to be the source of organism growth. If one were to connect a continuous infusion hub-to-hub without any add-on pieces, and leave this connected for the entire duration of 96 hours, open it only to change the continuous set, there is a smaller risk of contamination because there has been less manipulation. NCs were designed to allow for intermittent entrance into the catheter lumen without opening the lumen for each dose of drug. There is no indication to use them in a continuous infusion system and I strongly believe their presence encourages bad practice because it allows for anyone to frequently disconnect the continuous set without concern for what is infusing, what that would mean clinically for the patient, how to protect that male luer of the set while disconnected, etc. There is no research on this yet, however the use of NC for continuous infusion was included in the 2014 SHEA Compendium as having no science to support their use. Once an aspect of care gets attention such as that, the research usually is then conducted. Lynn

To answer your question:  The CDC guidelines are written to prevent CRBSI.   The INS standards address many thngs, including CRBSI.  The CDC Guidelines state to change the needleless connector with the admininstration set.  They are also confusing as they state to change the tubing for intermittant infusions every 24 hrs.   Then they state there is no advantage to changing the connector more often than every 72 hrs.  

These guidelines were also based on research done prior to 2010, since then, there has been more research done on connectors and newer products on the market, and some older products removed from the market.  You need to consider this when writing your policies.   Do you have pre-2010 technology  or something newer? 

The CDC Guidelines also state that tubing and add on devices should be changed at least every 24 hrs for TPN and Lipid based products. 

If reducing infections is your goal, then you may want to consider implementing these guidelines. 

In regards to LH's comments about not using needleless connectors for continuous infusions, I feel it is a safety issue for the patient.  Without a needless connector on the catheter, there is a greater risk of bleeding from the catheter if the continuous infusion is stopped or disconnected for any reason, including accidental.  Patients get confused, care givers try to "help", and even other clinicians may disconnect the infusion improperly for some reason.  In addition to bleeding, there is then the risk of hub contamination.   If a needleless connector is contaminated with blood or microbes it can be cleaned or removed, the hub cannot be.  The intraluminal surface of the hub which leads to the intraluminal surface of the catheter is not protected without a needleless connector. 

The practice of changing needleless connectors after blood draw is recommended by manufacturers who have needleless connectors that do not clear 100% of all blood and proteins with a typical flush.