I have a question regarding the practice of "looping" the end of the IV tubing to a port on the same tubing.
Was wondering how many of you have seen this practice and/or know if your hospital IV policies endorse it??
From what I understand, this practice is not recommended by the INS as their standards state, " a compatible sterile covering should be asceptically attached after each intermittent use."
This is a practice we're dealing with at my hospital but I was curious how many other places are seeing it?
I am in synthesis rotation right now. I have seen looping done but it drives me crazy. I just make it a practice to carry the little blue end caps in my pocket. I always cap it off. I did loop a couple times in a pinch but I just thought it was poor practice so I grab 2 blue caps at the eginning of every shift.
I am in synthesis rotation right now. I have seen looping done but it drives me crazy. I just make it a practice to carry the little blue end caps in my pocket. I always cap it off. I did loop a couple times in a pinch but I just thought it was poor practice so I grab 2 blue caps at the eginning of every shift.
Again, how is this any different then plugging two compatible meds into the same line??
I am not questioning your style of practice. It is just my own personal preference to have it end capped. Looping just feels disorganized to me. I think its a tomato tomatoh kind of issue.
The first time I saw this practice on a busy med-surg floor, I thought someone had forgotten to bring a cap with them, and used this odd connection mode for an emergency. After a while, at this and other hospitals I worked in the metro NY area, I saw that certain nurses used the "looping", as you call it, and certain nurses didn't.
Then I saw looping when no nurse had been near the area. It was the Nurse Assistants who were looping, since they had seen, just as I had, this cute little no-hassle answer to what to do when you have to change someone for the 4th time in the shift and there's no nurse around to unhook the pump-driven IV, or when your patient is halfway out of bed and the thing is stretched to the limit-- and no nurse around. No alcohol, and not always a glove change, never mind handwashing.
Then I saw looping when no nurse and no CNA was around-- the c.diff patient who is embarrassed to call the nurse yet again, when he wants to run to the toilet every 15 minutes, so he detaches and loops himself, and re-attaches himself when he gets back, usually to the correct tubing...
Looping is not recommended and has recently been discussed by the Institute of Safe Medication practices- ISMP. Please see this link and pass on these updated recommendations! It's all about patient safety-Thanks!!
Well, I'd agree if I could be certain that every nurse cleaned every port for at least 15 seconds every time they looped! Since I have not seen this done consistently and since blood stream infections are a major source of mortality and increased cost to our healthcare system- I have to agree with the ISMP and encourage clinicians to resist looping but to please do swab and cap as per the recommendation!
For the most recent reference to scrub time see the article in JAVA- Sept. Chinn/Kaler.
Well, when you uncap your port and hook it back up to the pt, aren't you cleaning the heplock too?
The same nurses who don't clean their ports when they loop are the same nurses who don't clean when they hook the port back in. In those instances, it makes no difference where that end has been.
Either people clean or they don't, and therein lies the real problem.
But, you'll never be able to convince me that looping is bad practice. Last pt I worked on had 5 running IVs going into one port on his central line. They were all plugged into each others port. It's the exact same thing.
I agree, the cleansing is the key... anytime a clinician skips that step, even if they think their ends or syringe are "clean" they put the patient at risk. Many nurses don't realize you should clean a port between accesses with a sterile syringe, but it is true. I would refer you to the manufacturer's directions for use of any product your facility is using. As far as "bad practice"- it is definately not easy to define as nursing has not been very good about backing up practice with evidence, but this is changing! Yeah! I am just hoping we can all work together to provide care based on "Best Practices"-
Specializes in Infusion Nursing, Home Health Infusion.
The INS cleary prohibits this practice. As an IV nurse for 22 years I have seen it all and I can tell you that a lot of nurses are not cleansing these injection ports. we are having a difficult time getting them to cleanse our positive pressure caps as well. Some nurses look at us annoyed when we (iv NURSES) insist that they cleanse injection ports and caps prior to medications and initiating infusions. The point is DO NOT LOOP. It is lazy sloppy practice and you need to ask yourself how would you like someone to care for your IV site?
HM2VikingRN, RN
4,700 Posts
I am in synthesis rotation right now. I have seen looping done but it drives me crazy. I just make it a practice to carry the little blue end caps in my pocket. I always cap it off. I did loop a couple times in a pinch but I just thought it was poor practice so I grab 2 blue caps at the eginning of every shift.