A significant number of Skilled Nursing Facilities in the community that I work are using the Red Cap from B Braun in the place of a disinfection cap, attaching it to the needleless end-cap when the CVAD is not being used. My concern with this practice is that because of the construction of the Red Cap, when it is applied to a needleless cap, the internal mechanism of the needleless cap is engaged, opening up the fluid pathway in a non-valved line and negating the function of the end-cap in helping to prevent blood reflux into the line. If it is a valved PICC, might it also open the internal valve of the PICC? Is my concern well founded, and can you think of other problems this practice might produce? What alternative might you recommend, as these facilities are unwilling to spend the money on supplying engineered disinfection caps?
Robyn Smith, RN, BSN, VA-BC, CPUI
Are you asking about a red tip cap used for other purposes, such as a syringe or tip cap, then reused to cover the needleless connector? These are single use devices and should be immediately discarded once removed from the first device. If this is happening, there are risk of infection and it is an off-label practice. This means the manufactuer is not included in any lawsuits because you have used the device outside of how it was intendeded to be used. I don't think these caps will open the needleless connector or internal valve on the catheter. These red caps would not have any antiseptic agent like those labeled as a disinfection cap.
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
We too used to see our facilities use these caps for this purpose when our pharmcies erroneously sent them out, instead of the sterile, single use white caps which are supposed to go onto the end of your IV administration set once the set is dissconnected from the needleless connector when giving an intermittent infusion. Whew, sorry for the run-on.... anyway, I find several reasons why this is problematic. 1. Nurses seemingly think that if they screw this onto the end of the needleless connector, no scrubbing is necessary. This cap does NOT take the place of an Curos or Swab Cap (alcohol caps) 2. Because this has a male and female opening, nurses have regretably luer-locked their filled syringe onto its exposed end, and then complained because the line is CLOGGED! This is a dead end cap! These caps are now not sent, except on the end of a CADD tubing, or prefilled medication syringe. Does this help?
Thank you for your thoughtful responses. The red caps are being supplied to this facilities as an alternative to the disinfection or really, just a protective cap over the needleless connector. You both make very good points, including off-label use, inadequate disinfection and inadequate alcohol scrub due to misunderstanding of the cap's function, the importance of not re-using the device, and understanding that the device cannot be used to push medications through. I have suggested parafilm may be a better way to protect the end-cap, as it is simple and inexpensive. Please let me know if you have other suggestions. Clearly education is the answer to avoiding issues that may arise from using this product inappropriately. Thank you!
Robyn Smith, RN, BSN, CPUI, VA-BC
Parafin! Hope you are not serious. That can become contaminated and it has not disinfectant properties. The standard of practice, based on strong evidence, is disinfection of any injection port or needleless connector is required before each entry. You can accomplish this with active or passive disinfection methods or a combination of both. Active is a manual scrub with a disinfectant pad. CHG/alcohol has produced the best reduction in CLABSI. Or passive disinfection from use of a true disinfectant cap. I think there are at least 4 brands available, maybe more. Passive disinfection adds the benefit of protecting between uses. The SAS procedure to give a med requires at least 3 entries so 3 times it should be disinfected. Those red caps should only go on the male luer end of the intermittent adminstration set being used for med doses intermittently over a 24 hour period. After 24 hours, they are discarded. Introduction of organisms through the catheter hub is the primary cause of BSI after the first week following insertion. This aspect of care cannot be ignored, overlooked or managed in a subpar manner.
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