Hello,
We recently changed our IV pumps for the BBraun infusomat. The BBraun tubing now comes with an anti-siphon valve that prevents checking blood return from a Y site on the tubing.
The anti-siphon is a removable part that is added at the connection part of the primary tubing and is intented to prevent freeflow when using the pump. The FDA and Ecri have stated that this is a crucial part of the tubing and that it should not be removed (for BBraun Tubing - when using the pump).
To make blood return verification possible, the company is recommending that we add a Y extension to the catheter below the anti-siphon valve and that we use the second Y site to check blood return)
Currently, in our inpatient oncology unit, we connect infusions directly to the catheter - without an injection cap - because there no disconnection of the infusion until the administration set requires a replacement. We see no benefit in adding parts to the systems.
We are questionning the balance of risks.
On one side, we are asked to add connection points, closer to patient - we see that as an increased risk of infection
The other option would be to remove the anti-siphon valve (This must be done when we administer by gravity anyways) and that would solve the issue as we could check the blood return on the Primary tubing lowest port. That options does not seem acceptable according to BBraun, Ecri and FDA for safety reasons (But yet we do it - and are told to do it - when we administer by gravity)
What are other centers doing? Has another institution had this issue?
Thank you very much,
Are you talking about short peirpheral catherers or CVADS or both? All PIVs need an extension set so you can easily work around the issue on PIVs. I can understand not wanting to add an extension to a CVAD and I applaud your removal of the needleless connector for continuous infusions. You must find a way to be able to check for a blood return on all medications but most importantly for any vesicant as a significant part of the site assessment for all VADs including PIV. I am familiar with other means to stop the free flow of fluid when it is removed from a pump. Several years ago, there were many issues and patient complications from fluid free flow. Have you contacted a clinical person at B Braun and not just the sales rep? That is what I would recommend. 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
Thank you so much for your reply Lynn.
So, to answer your questions.
I am talking peripheral IV and Central IV (but mostly central).
This said, we use the Nexiva peripheral IV catheter (without the Y site) and we do not add an extension. However, when we administer chemo-vesicant, we never use a pump so checking blood return is easy by just lowering the level of the infusion.
I have contacted the clinical support team - and not the sale rep - and she is the one who gave me the answer that I should add a Y extension. Currently, there is already an anti-free flow clamp on the pump to prevent free flow of medication when the tubing is removed from the pump. The anti-siphon valve is an additionnal piece of equipment also preventing free flow. However, it is not glued to the tubing and can be detached by accident (I have seen several disconnections at the level of the anti-siphon valve/tubing junction instead of the anti-siphon valve/needleless connector junction)
I have discussed further with my colleagues and am thinking of suggesting the following for CVAD's.
1) In adults: when administering vesicant solutions with the pump with a continuous infusion, I will recommend to remove the anti-siphon valve so that blood return can be assessed prior to the administration of the medication (From the Y site of the primary tubing)
2) In adults and peds : when administering non vesicant solution with the pump and a continous infusion - I will recommend keeping the anti-siphon and assessing patency of the CVAD by flusing the device prior to the administration (and checking for difficulty or inhability to flush, unusual shoulder, chest or back pain, edema, or complaints of hearing gurgling or flow stream sound on the ipsilateral side, paresthesia, neurological effect and pressure detection level on the pump). The blood return will be confirmed at the tubing change only.
3) I am still looking for an acceptable solution for peds or patients that are unable to communicate or with sensori-motor deficits. Any ideas?
France Paquet, RN. M.Sc. VA-BC(TM), CVAA(c)
Clinical Practice Consultant, Transition support Office
McGill University Health Center
Montreal, Quebec, CANADA
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
Your approach sounds reasonable. It seems to me that the ASV is only needed when you are piggybacking one infusion into another. The ASV would revent the primary fluid from backflowing into the piggybacked set. At leasst that is the purpose where I have used ASVs in the past. If you have another anti-free flow mechanism, I would say the ASV is only needed in those piggyback situations unless I am overlooking something here. 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