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?
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, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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
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
[email protected]
Turena Reeves
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.
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).
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, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861