When IV's aren't in use

Umrn1 · Jan 13, 2011

I am a new nurse with 7 months experience on a general surgical floor. Looping tubing is the norm. I need clarification on where looping is considered a risk when the port looping to is alcohol swabbed. We use blue quick connect caps on the patient side. The patient side is swabbed and new tubing attached. It seems to me that if swabbing the pt side before new tubing is attached is okay, then swabbing a port on the tubing itself is okay as well. In fact, the tubing itself is generally cleaner than the patient side anyway - unless it's been allowed to drag the floor or something I guess. More info would be greatly appreciated. This discussion has made me think differently about being more diligent in checking our IV policy and protocol :)

Little_Mouse · Jan 14, 2011

I did not know that looping was bad and that not capping a saline lock...I have not seen one nurse on my unit do either of these. My unit doesn't even carry any of those locks.

AnneS · Jan 16, 2011

We loop and do not cap saline locks. When we loop, we swab the port with alcohol and connect, and when we connect to the patient, we swab the patients iv port with alcohol and connect. My hospital doesn't even carry these red caps, although that sounds like a good idea. It would be interesting to see a study on this as apparently its not an issue at all where I work.

iluvivt, BSN, RN · Jan 18, 2011

The ISMP (Institute for Safe Medical Practice) has put out a warning statement on the practice of "looping"_ and states not to do it. Looping is only possible because of new needless designs......years ago all we had was a latex injection port that could only be accessed with a neelde. So essentially to perform the practice we see today would be to put a needle on the end of the tubing and insert it into an injection cap. The safest thing to do with the lowest risk for infection is to use a sterile end cap on disconnected tubing that will be used again and NO swabbing the injection ports is not the same....you need to minimize the number of accesses into the system. I will see if I can get the exact wording on the ISMP site...OK

Umrn1 · Jan 18, 2011

Okay, minimize the number of accesses into the system. I agree is definately not the same as swabbing. Thank you for the post:)

KColeman1764 · Jan 20, 2011

Mommy of 2- I totally agree ughhh! I also throe them away which takes extra time that we usually don't have, as we have to start all over, but it is really safer for the patient. Every facility should have some form of sterile end caps- blue or red, whatever your facility uses. This type of care is completely against INS standards. I am actually studying for the CRNI exam in March so I am usually the one who changes all the tubing, labels it, and ensures sterile end caps are in place.:)

evilolive, BSN, RN · Jan 25, 2011

At my facility we attatch the blue caps to IV tubing not in use. We keep plenty of these in stock and I usually pull out between five and ten for my 12 hour shift.

A lot of nurses will use the tops from saline flushes instead of the blue caps, which I find irritating because half the time I find a "naked" IV tubing with the white cap on the floor. I also want to strangle the nurses who keep using wrappers from alcohol preps to cover the end of the IV tubing. Ugh!

Nurseinprocess · Jan 25, 2011

I also want to strangle the nurses who keep using wrappers from alcohol preps to cover the end of the IV tubing. Ugh!

I have noticed someone on my unit doing this lately. GROSS! As far as I know we do not have any extra caps to close off tubing not being used.

spongebob6286, BSN, RN · Feb 4, 2011

we have a cover to put at the end of the tubing where you connect it to the pt. (sorry i forgot what its called)

kayty83 · Feb 4, 2011

ScoutLeader - you mentioned that this is wrong: " 5. an IV tubing set that is connected to a daily abx bag"

On my unit, we frequently run an antibiotic or other piggy back through a secondary line connected to the primary line at a Y-site. Typically, when the antibiotic is finished, the primary is allowed to continue running with the old piggyback and line still attached (and empty). If the patient has no primary fluids ordered, we will disconnect the entire set from the patient, cap the end, and leave it hang. (A full primary bag of fluid with an empty piggyback and secondary line still attached) As long as the tubing isn't expired (96 hours at my institution), we will reuse it when the next piggyback is due. If it is the same antibiotic, I just backflush the secondary line once to fill the secondary tubing with saline prior to use. If it is a different drug I back flush 3-4 times, emptying the drip chamber into the old secondary bag between each flush, and then connect the new bag and attach it to the patient.

Did what I described fall into the category you mentioned above of bad procedures? If so can you explain why, and what the proper management would be? Should I be disconnecting the entire secondary line and discarding it after each use? (A new secondary tubing for each new piggyback bag?) Thanks!

IVRUS, BSN, RN · Feb 7, 2011

kayty83,

What you're describing is not wrong. If the primary, liter bag stays connected to the patient so as to infuse the solution at an MD ordered rate, then the secondary IV tubing can be back flushed using the primary IV fluid to do so, (of course, compatibility has been assessed) and then both tubings are good for 72 hours, or in your case 96 per your institutional policies. It is when they are disconnected from each other, or the primary is disconnected from the patient's IV catheter that trouble begins. All of that manipulation increases contamination chances and so these tubings are only good for 24 hours.