Hi- I need clarification on how often the extension tubing on a PIV needs to be changed when you are practicing clinically indicated removal.
The extension tubing that I am referring is the needless cap and tubing all in one (the cap does not come off of the extension tubing) and the extension tubing is separate from the angiocath.
Per INS Standard 34 Needless Connectors it states : "For peripheral catheters with dwell times longer than 96 hours, there are no studies on changing the attached needleless connector/extension set".
Per INS Standard 36 Add-On Devices it states: Change the add-on device with new vascular access device insertion, with each administration set replacement, or as defined by the organization, and whenever the integrity of the product is compromised or suspected of being compromised".
Would the extension tubing that I am referring to be considered a needless connector or an add- on device?
If it is considered an add-on device it would need to be changed q 96 hours with the administration set replacement. For clinically indicated this seems to be a lot of "manipulation" with the PIV......
Now if it is defined as a needless connector it would seem to me that it should be changed with the piv dressing change (at least every 5-7 days per INS Standard 41).
I apologize if this post is confusing....
Thank you in advance!
I totally understand your question and this "conflict" in the SOP has been brought to our attention. These are 2 separate devices. IMHO, I would prefer to use an extension set without a bonded needleless connector. Leave the extension set permanently attached to the catheter hub until PIV is removed. Change the NC at 96 hour intervals. There is lots of evidence showing the NC as a risk factor for harboring organisms. We have no data on extension set use. Think about the brands of short peripheral catheters that have an extension set permanently attached like BD Nexiva. Those extension sets can not be changed, ever as they are built into the catheter wings. We don't worry about those remaining attached. You will be within the SOP to change the extension set when a new catheter is inserted. What is your outcome data on dwell times for your PIVs? What lengths of dwell are you actually seeing? Just because you may have a policy to change a PIV when clinically indicated does not automatically means that you are having lengthy dwell time. Studies still show the majority of PIVs fail within 48 hours. In case you are having lengthy dwell time, you should do some education to emphasize an aseptic connection when the extension set is attached to the PIV hub. With blood coming out, it is easy to contaminate that connection. Is there anyway you can use an extension set without this bonded NC? 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 so much Lynn. Unfortunately at this point we can not change to an extension set without a bonded needless connector or change to a catheter like BD Nexiva. We are just rolling out clinically indicated so we do not have any data yet but I agree with your comments about lengthy dwell times.
Once again, thank you!