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Connector Changes

The entire discussion of connectors can be complex. Literature about connectors discussing care and maintenance in a study format are really not available unless you look at the manufacturers invitro studies about bacterial ingress and catheter clearing.  The fluid pathway design impacts the amount of Fibrin that collects within the fluid pathway.  Many of you have seen cutaways of ports and know what this looks like.  Positive pressure designs have the most tortuous pathways and the largest amount of deadspace.  Positive pressure connecors have been identified with increased CRBSI rates and is now not recommended as part of a CRBSI reduction program in the recent SHEA et. al compendium.  When withdarwing blood into the syinge to identify correct placement all connector deadspace is filled with fibrin.  This also occurs with blood draws.  But filled deadspace is just that.  It is not the procedure but the withdrawal of blood into the connector.  Bacteria such as Saph e have fibrin identification methods and will attach to fibrin that is present.  Some practitioners are changing the connector when changing the tubing, some are changing once a week and still others have no policy for changing.  The most important issue when determining a procedure is patient outcome.  When looking at CVC cre and maintenance of which connector care is an important part it is therefore important to look at how the connector is designed and how the connector is being used.  High deadspace + high usage vs  Low deadspace and/or low usage.  A day of the week or a number of hours may not be the best way to determine practice.  I personnaly feel that that old saying individualized plan of care may be the only true method for achieving the outcomes we all desire.  Looking to physician based research may not lead nursing practice where we want to go.  Practice based evidence as often reported in posters and quasi-experimental or descriptive reports by practicing nurses may be more useful.  Successes can be found in the literature. 

Denise Macklin