Are needle connections still used?

[sistrmoon, BSN, RN]

An online acquaintance of mine just got an IVIG infusion at home. She said the nurse used a gravity infusion set and was hooking together dextrose water and the IVIG and was using a needle connection(and the nurse apparently pricked herself with the needle connection and was bleeding and still connected the tubing, ugh.) I thought everything was leur lock now. It boggles my mind anyway that IVIG would be to gravity, we tightly control and titrate rate in the hospital, but the needle connection really confused me. Any insight?

[Rose_Queen, BSN, MSN, RN]

A lot of our EMS groups are still using needle connections. Part of why the policy states that pre-hospital IVs have to be replaced or d/c'd within 24 hours.

[KelRN215, BSN, RN]

All connectors I use in home health are needleless/luer lock. Some of the gravity type sets have a "dial-a-flow" where you dial the rate but it's not always accurate... I hate those things, infusions in pediatrics always take twice as long as what the rate says since kids have small PICCs.

[RunBabyRN]

I do home IVIG infusions, and I avoid gravity like the plague. Pumps, titrate, all that.

I also don't use dextrose- the infusions I have are Gammagard, so I don't have to mix anything. I've mixed other human proteins (Zemaira in particular), but that was with the sterile water (or saline?) it came with.

That said, I when I do have to put the IG into a bag, I use the old technique with an 18g needle. No luer lock on the IV bag. Same goes when I premed with diphenhydramine- I draw it up with an 18g. I'm glad I learned how to do this in the military, because I never saw it even once in nursing school.

The only luer is on the adapter I'll put on the extension tubing or the port access, and then I'll connect the IV tubing to that. Even the access ports on those are the old school needle connection type. I've been surprised at this, especially because I am subcontracted through an agency to work with a variety of pharmacies, and they all seem to do it this way. I'm guessing it's less expensive?

Pretty bad that the nurse used the needle after sticking herself with it. I would guess that it had to do with the company sending the minimal supplies needed, and there wasn't another needle? Not an excuse by any means, just saying. I had to go to the local hospital Friday night because the company sent minimal flushes, and the first IV site failed me. This was the first home infusion where the company hadn't sent 4000 saline flushes, of course.

I agree with KelRN215 about the dial flow tubing- they ALWAYS run slower than the dial says, even with adult pts.

[sistrmoon, BSN, RN]

I asked if the nurse was wearing gloves while connecting the needle connections and was told no. I was taught gloves when handling IV tubing period.

[sistrmoon, BSN, RN]

And I asked if it was when the nurse mixed the IVIG with the fluid? That would make more sense if it had to be mixed in a bag. But she said it was two bags, with the tubing connected by a needle connection. I told her to take a picture next time.

[RunBabyRN]

And I asked if it was when the nurse mixed the IVIG with the fluid? That would make more sense if it had to be mixed in a bag. But she said it was two bags, with the tubing connected by a needle connection. I told her to take a picture next time.

Yeah, that sounds weird. I'd be curious to see a pic, too!

[AnnieOaklyRN, BSN, RN, EMT-P]

I work on the ambulance and in an ER and in both places we use needless systems (calves).

HPRN

[Asystole RN]

I asked if the nurse was wearing gloves while connecting the needle connections and was told no. I was taught gloves when handling IV tubing period.

Outside of the hospital this is relatively common, the focus is on hand washing not wearing gloves.

Just think to yourself, what is the main purpose of wearing gloves and why did they become common place (historical).

I personally do wear gloves and advocate their use if they are available but the choice is nurse and facility dependent.

[Asystole RN]

Needless connections are not universally used, especially not in home health/home infusion. Really depends upon the pharmacy or company providing the supplies. Keep in mind the nurse rarely has an option.

Generally if the patient is a candidate for home IVIG infusion they are stable and tolerate IVIG very well. It is not unusual to gravity drip in the home setting at all. In fact, many (most?) of my patients actually infused themselves and set their own rates. Not unusual at all in the home.

[Asystole RN]

And I asked if it was when the nurse mixed the IVIG with the fluid? That would make more sense if it had to be mixed in a bag. But she said it was two bags, with the tubing connected by a needle connection. I told her to take a picture next time.

Not unusual either. If for some reason you needed to slow or D/C the IVIG you would still have fluid to give, if you mixed then you are out of luck. Always opt to keep the meds separate from the fluids so you always can at least have fluids if the meds do not work out so well.

[RunBabyRN]

I've had a couple of new IVIG patients who have never received it, and we have to titrate up slowly and monitor sxs PRN. I have a new guy this coming weekend, in fact.

i haven't yet seen a pt self-infuse IVIG, but I have with plenty of other stuff. Most of my pts experience at least some sxs (fatigue, haywire VS, headaches, etc.), so probably safer to have a RN present.