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stemc
PLEASE HELP WE NEED AN OPINION

Please help answer a question...We need to know if people are wearing gloves when changing endcaps on PICC or any central line.  We have different opinions in our dept. and would like some input.  2 of us wear gloves when performing this procedure and one does not.  The one who does not was approached that they were going to get written up if it was seen again and she is insistent that gloves do not need to be worn.  She said she had seen a post on here about it that gloves are not to be worn, I could not find it anywhere.  So we are looking for literature or just any input to support either way.  Thanks.

lynncrni
I have never seen any studies

I have never seen any studies pro or con regarding using gloves to change a needleless connector. Or to change any tubing for that matter. I would begin to find the answer by checking the packaging on your specific brand of connector. Is it labeled as "sterile" or is only the fluid pathway sterile? Even if it comes from the package in a totally sterile manner, it is being attached to the catheter hub and its exterior is certainly not sterile. I would not say it is wrong to use gloves for changing the needleless connectors, but I can not say that it is necessary and certainly not required by any set of guidelines or standards that I can recall.

What group of nurses are changing these needleless connector - IV team or primary care nurses? What level of compliance is there with proper technique to maintain the male luer connection in a sterile fashion? Are they moving so fast it is highly possible that contamination will occur?

The problem with needleless connectors is the entrance of organisms with each use. These devices definitely grow biofilm and increase the risk of BSI if not properly maintained. I would rather see the emphasis placed on protecting the connection surface of the needleless connector by using one of the new protection caps between using the connector and thoroughly scrubbing all surfaces (connection surface and luer lock threads) with a new alcohol pad before each and every connection. It is the organisms on the exterior of the needleless connector that gets forced into the lumen with each use that poses the risk. Also you must pay careful attention to how you manage all intermittent IV sets. They must be capped with a new sterile end cap or blunt plastic cannula after each use. Leaving it uncapped, attaching to another site on the same tubing (known as looping), or using something like the foil package from an alcohol pad or the tip cap from the flush syringe is not sufficient to protect this tubing. This tubing also must be changed every 24 hours. No studies have shown that it can be used for a longer period. You can scrub the needleless connector properly but if you are connecting a contaminated tubing, you are still putting the patient at risk for BSI. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

AMParry
Need an opinon - gloves vs no gloves for cap change

Gloves (non sterile are good) should be used as there is is the potential of contamination of both the line and the caregiver.

Using gloves helps us to remember this is serious and the need for aseptic technique to prevent line infections.  I use gloves as you never know if you are going to encounter blood or other fluids/medicationsn (like a Chemo) on the hub of the line that may pose a risk to the person changing the cap.  To me it is just good practice and common sense.

 

Ann Marie 

 

Ann Marie Parry RN CRNI

RN Clinical Coordinator

[email protected]

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

momdogz
It doesn't matter so much what the differing opinions

 in your department are, what matters is your institution's written policy - staff compliance is measured from policy.  Discuss with your experts, Infection Prevention, and whatever you decide make sure it is stated clearly in your policy.  Then all employees are held accountable to that policy.

I agree that non-sterile gloves should be worn for all of the reasons stated in this thread.  I would go as far as saying gloves should be removed and hand hygiene repeated immediately prior to performing an aseptic no-touch technique connection to a needleless connector.  In other words - you could have gloves on while you're positioning the patient, moving the sheets around - contaminating your gloves.  I would not use those gloves when connecting to a vascular access device.  Change them.  

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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