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afruitloop
Regarding tubing changes

I was presented with a situation today that I did not know the anser to and I call on my vascular access friends here on the list serve.

On intermittent tubing (antibiotic) I  know that it need schanged every 24 hours.  I assume that that means when a needle or needleless device is luerlocked on the end of the intermittent tubing that the needleless device should be changed with EACH antibiotic hung. 

The question is.... what happens when that intermittent tubing DOES NOT have a needle or needleless device  on the end of it, this would be so that the intermittent tubing gets directly accessed into the saline lock or primary tubing.  How often does it need changed?  My thought is that every 24 hours may not be enough, because the tip of the tubing has then gone in and out of the primary line or saline lock, 3 or 4 times during the course of the day, every time the med is given.

Hope this makes sense.

mary ann ferrannini
 It seems to me it would be
 It seems to me it would be cost effective to use a sterile end cap on the intermittent tubing as opposed to a needle (also safer) or needleless injection cap. They are cheap and available in a variety of colors. Our IV team requested red so it is easily seen. Our nurses then remove the sterile end cover...scrub the cap on the saline loc and attach the intermittent tubing. Once the infusion is complete....they disconnect and reapply a new sterile cap. As long as the sterility of the end of the intermittent tubing has not been compromised the hang time is 24 hours. We do not allow our nurses to loop the end into another injection port on that tubing. They try but we have clamped down on that bad practice. Hope this answers your question. What product or system are you using?
lynncrni
Mary Ann's description

Mary Ann's description follows the INS standards of practice exactly. Cheryl, see Standard 48, II Practice Criteria C & D. You can either use a blunt cannula or a sterile tip cap, placing a new one on the end of the tubing after the infusion is complete. The challenge is having those cannulas or caps readily available at the bedside in all settings. Tip caps are cheap, easily obtained and come in a variety of colors. It is imperative though that proper attention be paid to maintaining this tubing in an aseptic manner between doses. Policies should also be very clear about discarding the tubing if blood has back up into it or if it is compromised in any way. We have put a lot of emphasis on the infection risk associated with needleless connectors but no one is really looking at the tubing that is being attached to these connectors. When these tubings are managed in such a careless manner, we can not blame the needleless connector for the resulting infection! 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

mary ann ferrannini
 Lynn you are so right on
 Lynn you are so right on with your comment about the mismanagement of these tubing. I have seen nurses priming these with the end dangling on the floor,the end not covered and just hanging anywhere, the end stuffed into an open alcohol packet,and on and on and on. Worse yet is the absolute laziness of not properly scrubbing the cap b/f attaching the tubing or anything for that matter. One of my coworkers puts a tight knot when she finds any tubing like this. Sometimes the nurse will get irritated when I discard the tubing and then tell them why!!!!! I will never take shortcuts like that or refuse to speak up.
afruitloop
Thanks ladies for your
Thanks ladies for your responses.  You gave me just what I needed.

Cheryl Kelley RN BSN, VA-BC

Robbin George
If a flushing syringe or
If a flushing syringe or the needleless cannula that connects the tubing to the access device are "single use" why is it acceptable to reuse the tip of the intermittant tubing in the same way?--Putting a sterile cover on the end of the tubing inbetween doses in a 24 hour period does not change the fact that the tip has already come in contact with the patient and therefore by definition is used and should not be reused--I think that was the thrust of the original question.   

Robbin George RN VA-BC

lynncrni
You make a very good point.

You make a very good point. I think this is based on an "assumption" that nurses can maintain the male luer tip of the tubing in an aseptic manner. This may have been true when we were placing a needle on the end of this tubing and it may be true today with a blunt cannula covering the male tip. But now that we are connecting a bare, open male end directly to the mechanical valve needleless connector, who is to say that this can be maintained in an "aseptic" manner? As I have mentioned, published, and regularly teach, there is not one data point ever published on the use of intermittent tubing. All tubing studies have been conducted on continuous tubing. So we really do not know what is on the ends of all that intermittent tubing. I shudder to think what is happening on those sets that are used for 72 or 96 hours!!  

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Robbin George
I personally not only "scrub
I personally not only "scrub the hub" but have made it a practice to scrub any tubing tip I am asked to reconnect after restarting an IV or after stopping an infusion for lab draw or CVC drsg change--This not in any policy but it is something that just seemed like a good practice 

Robbin George RN VA-BC

lynncrni
Well, it may or may not be.

Well, it may or may not be. There are no studies on doing this so we just can't say. There is one study on improper use of multidose vials leading to bloodstream infection that states there can be 1 million RBCs in solution without a color change. So there can be blood contaminating the fluid in the tubing tip without ever seeing that blood is there. So cleaning may not have any affect on this. Also, some alcohol pads are labeled as sterile and some are not. What are you actually cleaning this tip with? Lots of questions but very few answers yet.  

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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