A few questions have come up recently when someone went through my institution's IV policies with a fine eye. 1. How do you keep track of needleless connector changes. We currently say change every 7 days with dressing change. However, someone pointed out that sometimes dressings are changed more frequently and we lose track of when the caps need to be changed. Would like to know how others handle this and if they have compliance. 2. We advocate NOT placing a CHG impregnated sponge on a site that is oozing/bleeding or if the patient has excessive diaphoresis and the dressing is being changed frequently. Would everyone agree with this? 3. Is Sorbaview considered in the same category as tegaderm and changed every 7 days?
Thank you so much,
Kristi Selck, RN
Clinical and Evidence Based Practice Council
Shands Hospital
We also change the needless connectors every 7 days with the dressing change. If the dressing needs to be changed sooner, the needless connectors are to be changed as well. We also use the CHG impregnated disk with every line regardless of oozing. After the line is inserted, we clean the site with a CHG sponge then hold pressure with a dry 2x2 for 2 full minutes, then apply the CHG disk. This significantly reduces post insertion oozing. The SorbAview shield dressing is marketed for 7 day dressing changes and hold up very well. We have a central line dressing kit that includes all materials needed including the CHG disk, needless connectors and SorbAview shield dressing.
Linda C. Smith, RN
There are no guidelines stating that a needleless connector can be used for 7 days. I would strongly recommend they be changed every 72 to 96 hours, according to the CDC guidelines. 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
We have just updated our EMR to address the change of needleless connectors. We use EPIC across all 5 hospitals and all ourpatient services. In the IV doc flowsheets, we recently added a row for the date the connectors need to be changed - 96 hours and prior to all blood clutures. Since this is new, we are still in the education phase so I can't address compliance at this point. As stated in another post, we hold pressure until bleeding has stopped then place the sponge or CHG dressing generally without problems. If we do have someone who is bleeding, then we will use a thrombin product, change the dressing in 24-48 hours depending on whether this has worked or not. Generally, it has been successful so we go to the regular dressing with either the sponge or CHG dressing.
Sorbaview is considered acceptable for Q7 day changes I believe.
Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access
I agree with Lynn. We change them with our tubing changes.
Lynn,
I can't find a CDC recommendation other than: Change needleless connectors no more frequently than every 72 hours or according to manufacturers’ recommendations for the purpose of reducing infection rates [187, 189, 192, 193]. Category II . Our IC dept. does not read this to mean change at 72. We are just getting in the Nexus TKO-6 and the Curos cap protectors. We also use EPIC. If we change with tubing change, difficult to monitor for intermittent infusions. EPIC line might be best solution. Can you point me at evidence for 96 hour change?
Thanks
KRisti
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
See the section entitled, Needleless Intravascular Catheter Systems.
Statement #1. Change the needleless components at least as frequently as the administration set. There is no benefit to changing these more frequently than every 72 hours. .
#2. Change the needleless connectors no more frequently than every 72 hnours or according to manufacturers" recommendations for the purpose of reducing infection rates.
The section on administration sets separated continuous from intermittent sets by stating that change of intermittent sets is an unresolved issue. The first statement in the needleless connector section is a bit confusing because they did not specify which type of set they were referring to, however I am thinking they were referring to the continuous sets which are changed no more frequently than 96 hours as the CDC did not make a statement about the change frequency for intermittent sets.
Other than the CDC statements to change at some point between 72 to 96 hours (my interpretation), there are no sltudies that show evidence for change at any speciifc point in time. Manufacturers do not test by a number of days. They test these devices by a number of actuations or activations - the number of times there is a connection to the device. This testing is done for the purpose of how many connections the device can tolerate and still function correctly. There are no studies that have looked at the infection rates with a specific length of use, again a confusing statement from the CDC. Contact the manufacturer of the device you are using to learn their instructions. 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
There are needless connectors available that come in two colors. You can use one color for one week, the other for the following week. You can post in your EMR "news" page (some have that as a home page) or on your units which color week this is. Another way to insure compliance is to include the needless connectors in your central line dressing change kits. That way, with every dressing change, the caps are right there to remind the nurse to change them out. This should be done with the "as needed" dressing changes as well, so no matter when the dressing is changed, but at least every 7 days, you have a connector change.
You are correct about the CDC guidelines, and the INS states: The nurse should change the needleless connector in the following circumstances: if the needleless connector is removed for any reason; if there is blood or debris within the needleless connector; prior to drawing a blood culture sample from the catheter; upon contamination; per organizational policies, procedures, and/or practice guidelines; or per the manufacturer’s directions for use. The nurse should be knowledgeable about the manufacturer’s directions for use and other device performance criteria to assist in the development of policies and procedures for needleless connector change frequency. The optimal time frame for changing the needleless connector has not been determined (see Standard 49, Infection).7,8,22,37,42,43,44,45,46 (IV)
Chris Cavanaugh, RN, BSN, CRNI, VA-BC