Break away valve for central IV lines

annie.rn · May 21, 2015

If I understand what you are saying, the breakaway part would be at the point where the IV tubing and the PICC (or other central line) tubing connect?

If that assumption is correct, I can see pros and cons:

Pros: if the pt. pulls at the correct point (i.e. below the breakaway valve) it would prevent pulling of the central line. Otherwise, it would not, correct? Could the pt. still pull out the line if they pulled above the breakaway?

Con: Pt.s aren't always hooked up to an I.V. In this case, the valve would not serve a purpose.

Con: Infection control. Once the valve breaks apart how would the two exposed ends be kept clean?

Con: Properly titrating the amount of pressure needed to trigger the breakaway. Too little and every little snag on the bed rail or BSC could cause it to break apart. Too much and it will not serve its intended function. It would be very important for it not to break away too easily b/c if it did and the nurse did not know it, the IVF could be running without being connected to the pt. There would have to be a mechanism whereby the flow of IVF is stopped if the valve breaks away which would then cause the I.V. to alarm.

Com: Stat locks already exist and seem to work pretty well in preventing pulling out of lines.

In the case of a hep locked PICC, maybe you all could invent a better version of the stockings that we currently use to put over I.V.'s and PICCs to prevent pt.'s from messing with them. If you've got a really confused person, those stockings are of no use whatsoever.

I like the idea but would have to know more about it to decide if it would be something I'd like to use in practice.

SierraBravo · May 21, 2015

Another con would be if the patient has chemo infusing and they decide to pull the line and it "breaks away". And now, you have yourself a chemo spill as well as possible chemo on the skin of the patient. No bueno.

nightnurse93 · May 21, 2015

Hey Annie and SB! Thanks so much for the awesome feedback!

Annie: your assumption is correct. The breakaway valve would separate in two sealing the site opening and tubing.(kind of like a break away valve that's used at gas stations)

So from what I understand, the break away valve will be a "true" disposable and the physician will attach a new, sterile breakaway valve once the adapter has separated. When there is a separation, the IV pump could alarm if it senses a distal occlusion.

You bring a good point when mentioning how tightly attached the breakaway valve should be. I'm not sure if they are doing any lab testing to show the appropriate range of tension that's needed.

annie.rn · May 22, 2015

Only the physician would be able to replace the valve once it has broken away?

That's a major "lim fac" in that doctors are rarely around at night in non-teaching hospitals. This would cause an unreasonable interruption in care.

nightnurse93 · May 22, 2015

Hey Annie

Sorry for the confusion, either the physician, physician's assistant, or nurse would be able to administer or replace the breakaway valve. In this case, would you consider using it for practice?

annie.rn · May 25, 2015

I'm always willing to give new things a try :-)

calivianya, BSN, RN · May 27, 2015

I think they would be just as useful for peripheral IVs, not just centrals.

We had fewer resources at my last job. Read this as: no IV team at night and no one willing to drop a line, so peripherals were all we had at night if someone needed access. I remember one patient who we stuck at least 15 times between six or seven different nurses before someone finally landed a 24 on his right foot. Yep, we got desperate enough to try a foot IV because he was a bad GI bleed and really needed Protonix/Octreotide drips.

He got out of bed because he was confused. You can guess what happened to that IV. A breakaway valve would have been amazing in this case so the one IV that took more than 15 tries to get placed wasn't lost.

nightnurse93 · May 27, 2015

How do you guys see the potential use of this adapter compare to something such as SecureAcath?

MunoRN, RN · May 29, 2015

I'm all for the general goal, but I don't see this particular idea as being of much use. I've had many patients remove IV access, but not once have they grabbed the IV tubing and pulled it out, they have always grabbed the IV at the insertion site, so a breakaway adapter would be of little use, and probably more of an annoyance as it comes loose on various trips to CT, turning, etc.

annie.rn · May 29, 2015

How do you guys see the potential use of this adapter compare to something such as SecureAcath?

It would not replace the use of a securing device at the point of insertion. The adapter you describe would be attached in line with IVF, correct?. If no IVF are running then you'd need a SecureACath or StatLock to keep the line protected.

As MunoRN said, pt.s will very often grab and pull at the insertion point of the line more than they will at the tubing. This makes any type of securement device ineffective.