Closed system for ABG draws from UAC?

[Bortaz, MSN, RN]

We use a transducer/stopcock system that is not a closed system. It's basically an open port (capped, of course...some even leave a syringe on it) from which we draw the blood, switching out between the syringe used for the first 1 ml (returned to baby), the heparinized syringe we give to the RT for the gasses, and the flush.

I'm still new, but this doesn't seem the best process, to me. Our NICU has the highest rate of bloodstream infections in our hospital, and since our patients are the most jeopardized by becoming infected, I'd like to find a better, safer, more sterile system for doing these draws.

Is there a closed system available? What is your procedure like in your NICU? I'd like to find some evidence to take to our director if it's possible to improve on our system.

[labordude, BSN, RN]

I have used multiple systems at different hospitals. Several have started implementing a closed system similar to this one http://www.accessmedicalsupply.com/content/bp3_competency/educational_program_for_bp3_closed_system.pdf. It basically uses vented syringes and two ports that allows enough blood to be pulled back so that your draw is clear of heparin, but then uses a pre-connected bag of whatever you are using to flush back down without changing syringes. I'm a fan

[ittybabyRN, RN]

Our unit uses a closed system, I cannot remember the name of it though, when we set it up we have the regular IV tubing that connects to the transducer and what we call a "kids kit" that includes a "pigtail". THe pigtail is a long piece of tubing connected to a syringe, the a-line fluids are in this syringe, we can pull back on the syringe and pull back blood from the a line intu the tubing, this "waste" is later returned to the infant, in between the infant and this syringe there is a port that can be accessed by a special needle, but I dont know what this whole setup is called. It is closed though

Also our PICU and PCVICU use this product VAMP Jr. System

its pretty similar, I'm not sure why we don't use it in our NICU since the PCVICU uses it in their neonates.

[Bortaz, MSN, RN]

Thanks for the links. I'll look at those and see what they're about.

[littleneoRN]

We use a closed system, and I love it!

BTW, you'd be better off comparing your infection rate with other similar NICUs than other types of units in your hospital. It's kind of apples to oranges if you're comparing with kids or adults. Is your unit part of Vermont Oxford?

[Bortaz, MSN, RN]

No, I do not believe we are part of Vermont Oxford, as I've never heard of that. LOL.

[littleneoRN]

That's alright! Vermont Oxford is a network of NICUs that submit data on all kinds of patient care practices and outcomes. Then, the network can analyze variations in practice and see what are associated with best outcomes. This is a way of identifying potential best practices in the NICU. Amongst many other things, we get data on how we compare to other NICUs. (Not to compete, but to know whether we are doing things well.) So we will hear how our rate of bloodstream infections compare to other NICUs. The data will be adjusted for number of patients and acuity, so that they can tell you how many infections might be expected given the size and acuity of your unit and then how many you actually had. It's helpful if you're looking to identify strengths of your unit and areas for improvement.

[BittyBabyGrower, MSN, RN]

We use biosensor...not one umbilical line infection for going on over one year. We will also put it on central lines for the bigger kids that we draw their labs off of (they have a separete set without a transducer).