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Infusion Caps and Rapid infusion

Posted

Hi,

I have spent the last few hours trying to find information on how much, if at all, infusion caps restrict the flow of a rapid infuser like the Belmont in a PIV. I have found very little information ranging from they are very restrictive to not at all, device dependent.

I am curious if the caps should not be used in a massive transfusion scenario or any that would require large amounts of fluid/blood quickly in the trauma room and likely on their way to the OR.

In my current practice I use these caps with all my patients, and have used them inline with the Belmont, primarily for ease of disconnecting the lines without spilling blood everywhere.

I am not at my primary work place now and am working overseas for the time being and the question came up. I had never questioned it before, it had never been a problem.

If this is not the best practice, what is? What do you do? Do you have articles to support?

Thank you for your intrest.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

The most 'constricting' connector I know of is the microclave, although even that can handle 600 ml/minute or 36 liters/hour. Typically it's going to be the IV itself that is the limiting factor. If you've got a large bore cordis introducer as access and you need to get in a liter per minute then it might be worth taking off the caps, otherwise it isn't going to slow you down.

That's what I was thinking.

I did my own trials with our Belmont and found that the caps we use restrict the flow to about 300ml/min versus no caps and being about to flow around 650ml/min. using a 14g 1.25" cath.

Looks like I need to see if I can get us some better caps. What are you guys using?

I would also check with the folks over at CT- Not sure how the rate of a CT angio infusion compares, but certain IVs and extensions won't tolerate this. I thought they were being nitpicky and checked with the manufacturer- they ere not rated for that kind of pressure.

Maybe drop the cap manufacturer a note- they probably know.

These guys think it matters.

The link you provided just sends me to the general anesthesiology website. Funny though, that's how the question came about, I work with and CRNA and she doesn't like to use them. Whats the jist of what your link states?

Sorry for the duplicate post, still figuring out this site.

I would love to talk to CT, but we don't have one. We don't even have Xray. Very remote trauma medicine. Back home the stuff we use is power rated to include the IV pigtail extensions and I use them in my traumas.

Anesthesiology News

Try that.

"So we recommend that if you place a large catheter and you need to give fluids quickly, don't use a needleless connector,” Dr. Lehn said. Because as we noticed, if you put in a 9-Fr or a 14-gauge and then add the needleless connector, you're essentially putting in an 18- or 20-gauge, so why risk a large catheter if you're not getting the flow rates you're after? If it's a small case and you're only infusing a nominal amount of fluid, go ahead and put one on.”

And:

http://nursingcenter.com/cearticle?tid=1456147

"Clinicians should assess the amount of pressure a needleless connector can tolerate before using it for rapid-flow infusion (3 to 5 mL per second), which may be required in emergent procedures or in radiology. If anything obstructs the fluid flow, rapid infusion may produce pressures beyond those the connector can withstand. The connector's product information should state the amount of pressure it tolerates."