Many issues with staff not using sterile cap to cap end of iv tubing. We are finding nurses using the white cap from the prefilled saline flush or backing the tubing into itself. What are the issues with both these procedures? Need to present this to staff RN's with reasons why these are not correct and can cause contamination.

Also is anyone using a large red cap to cap the end of iv tubing? Do you have a brand name for this cap?

Are any hospitals keeping flush supplies (alcohol wipes, prefilled flushes, end caps) in a container attached to the IV pole itself? If so how is this working for you?

 

We use Baxter 2C6250

We use Baxter 2C6250.  Simple 15cent cap.  Single use for the Saline Locked MALE IV tubing side.

 

PICture:

 

plus.google.com/photos/110845237032889728552/albums/5714213665609484049

 

 Has the Loyola study been

 Has the Loyola study been published or is this a white paper from the DualCap manufacuturer? If published, I would like a copy. Thanks,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

Anti-Microbial Caps for needleless devices AND IV tubings...

There is a product out there called Dual Cap from Catheter Connections which is a alcohol imbedded protective cap which not only protects female luers (needleless devices or Y-Ports) but also has a alcohol cap for the end of IV tubings to protect the male luer end from contamination.  There is a study from Loyola University which shows there is more contamination on the male luer end of IV tubings than there are on the end caps (needleless devices).  

 

The male luer cannot be swabbed because swabbing could introduce toxic isopropyl alcohol (IPA) into the fluid path. Historically, the male luer has been overlooked.  Currently all the alcohol caps available on the market only protects the Luer Activated Valves (LAV) and not the end of IV tubings.  Preventing catheter related bloodstream infections requires that every LAV and male luer be disinfected and protected.  DualCap is a disposable, single‐use device containing two caps – one for the LAV and one for the male luer which contain 70% IPA and a patent pending delivery system that keeps IPA out of the fluid path.  It comes in different variations to protect all devices - male/female, female/female, female luers.
 
The red sterile caps do not disinfect the tubing ends (male luers).  Just like you would swab the needleless devices with alcohol, it is just as important to be able to swab and protect the male luer ends.
 
Facilities that are using the Dual Caps have noted a signficant and immediate reduction & elimination of CLABSIs.  Email me privately if you would like a copy of the Loyola Study as well as other clinical papers on the contamination rates of IV tubings.
 
Email: pdxshawny@gmail.com
 
Shawn H.

 

 The "red cap" is a product

 The "red cap" is a product by BBraun.  Product number R2000.  This product can attach to the end of IV tubing or (the reverse end) can fit on stopcock ports.  BBraun has a couple of others as well (blue cap). Other caps were evaluated, but this one met all of our needs and it's size was easier to handle than many of the others.

response: end cap for IV tubing

The practice of

1. not "repurposing flush caps" by using single use sterile female luer caps

2. maintaining the integrity of the IV administration set by Not Looping

are both a part of our IV care and Maintanance Bundle. Bundle compliance is monitored monthly with "in the moment (peer engagement)" and feedback.

Our CLABSI prevention team recommended a small wall mounted storage bin be placed outside of each patient room which houses alcohol wipes, female luer caps, and needleless valves.

These practice along with scrub the hub, hand hygiene, and limiting blood specimen collection via CVC's resulted in a 62% clabsi reduction.

Can send you pictures if you email me.

Turena Reeves RN OCN

Reevest@einstein.edu

What about the patient in

What about the patient in isolation? Would you still keep the caps and alcohol in room in bulk, say attached to IV pole. I know we don't change glove boxes with every patient but it seems that if you have to reach into a container there would be too great of a risk of cross-contamination. We need to invent a dispense that dispenses 1 endcap at the time!

 For using the tip cap from a

 For using the tip cap from a flush syringe, those are labeled by the syringe manufacturer as a one-time use only device. Using them a second time would be an off-label use and a practice that has no evidence to support that it is safe. Those tip caps are easily contaminated when being removed from the syringe, laid down on a table or bed and then placed on the IV set. 

For the practice of looping, or connecting the tip to another injection site on the same tubing, this is also a practice that has no evidence to support that it is safe. No IV set manufacturer would support it in their instructions for use. The male luer tip could easily be contaminated and when connected to the other injection site would spread that contamination to a greater length of the same set. This would then be allowed to sit for several hours before it is used again and any organisms would be allowed to grow. 

The only acceptable practice is to use a newly opened cap that is sterile inside and place it on the IV set male luer end immediately as it is disconnected from the catheter. 

B Braun makes tip caps of different colors but I am not sure of their tradename. 

I am convinced that the only way to ensure the correct practice is to have these supplies inside the patient's room. here is one study of a similar practice:

1. Stefancyk AL. High-use supplies at the bedside. Am J Nurs. Feb 2009;109(2):33-35.

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