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mary ann ferrannini
TPN and cap change frequency

  OK !!!!!  here it is another cap question. I want to change our Hospital Policy on needleless injection caps on our TPN patients....We mostly will place A PICC for these patients and I believe a cap change every 7 days is way too long..I have also noticed an increase in funginemias. What are others doing??????......I am looking for any data to support my quest...just got the new CDC draft with quidelines for preventing CRBSI's and am looking through that now

Are you asking about PN that

Are you asking about PN that is a continuous infusion in your hospitalized patients? If so, then why do you even have a needleless connector in the system anyway? This is definitely ***not*** needed, adds risk and costs. All continuous infusions should be connected directly to the catheter hub and ***only*** opened at the hub when it is time to change the tubing every 72 hours, every 24 hours if fat emulsion is being infused. If you have a needleless connector in this system, it must be changed at the same interval as the administration set. This connector is not necessary. It adds another luer lock connection which adds to the risk of disconnection. So now you have 2 connections that could come loose instead of one. And with the risk of BSI associated with some of the needleless connectors, I see no reason to have this device in any line that has continuous infusion running, especially PN with the high glucose and that added risk for providing nutrients for biofilm growth. These connectors are for catheters that are being used for intermittent infusion, not continuous infusions. I have never heard one valid reason for their use in a continuous infusion, but I am eager to hear one. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

mary ann ferrannini
 Lynn......I agree with

 Lynn......I agree with you.....long before we had needleless connecters..THAT IS HOW WE DID IT!!!! I think what has happened is that nurses have done it for convenience instead of what is in the best interest of the patient. The product we now use rarely comes disconnected...I can barely disconnect them sometimes they are so tight...Tx you for your what I will need to do is convince the nurses they need to do it this way...We do change the the tubing every 24 hrs if it is with Lipids

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