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daylily
Reducing tubing disconnections

In an effort to reduce disconnections at our acute care facility we are looking at:

Implanted port patient with a single extension adding a bifurcated extension set and changing the set on day 4 and with the needle change on day 7.

Currently when there is incompatibility of drugs tubings are disconnected and reconnected.  By using a bifurcated set, one side could be clamped and the incompatible could be run through the other side, of course flushing adequately before/after each med.

Would it be acceptable to use a bifurcated set and leave in place after a blood transfusion?  Meaning, the patient has continuous IVF running (which we would stop during a transfusion) but leave attached to one side of the set (and clamped) and run the blood through the other side.  Once the blood is done and adequately flushed, disconnect the blood tubing and turn on the continuous IVF which has remained attached on the other side.

Would the extension set need to be changed with TPN change or blood transfusion or could it be left in place as long as adequate flushing occurs and change on day 4 and day 7 with the needle?

lynncrni
 I don't think there is any

 I don't think there is any evidence to inform your decision on this one. The same thing is true for IV fat emulsion. Do you change the extension set as well as the administration set. I can definitely appreciate your efforts to reduce set connection/disconnections to reduce risk of contamination. I have also recently seen several new studies about the risk of infection associated with blood transfusion, but I don't think these were reporting on issues such as this. Blood has a negative impact on the patient's immune system and collection and storage processes are a concern. Several other concerns come to mind especially for implanted ports. One side of the bifurcated set could easily contain a dextrose solution, which is not acceptable for contact with blood transfusion. If the nurse turned on the side with the dextrose before all blood was cleared from the line, this could increase the possibility of occluding the implanted port. Medications mixed in that fluid could be an issue also. Even with a bifurcated extension set, there will be a small segment where all fluids come together. Clogging up an implanted port could be a challenge to declot. 

I would prefer to have the blood administration set attached directly to the extension on the port access needle without the risk associated with the bifurcated set in between. This would mimic the setup for a peripheral infusion where you have the catheter and a single lumen extension set and the blood set is attached to the luer hub of the ext set. That ext set is not changed when the blood is finished but it is flushed thoroughly with saline. The point is the blood is not able to contact any other fluid except the saline on the other side of the Y on the spike end of the set. So I would take out the bifurcated set before the blood is transfused and then connect a new set when it is finished. Again with nutrition, it is not the protein/carb/vitamins that is the issue. It is the IVFE. See INS SOP 43, Practice Critria IV. Parenteral Nutrition, Item C. 

Lynn

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

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