"Looping" IV Tubing

[RN CRNI]

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?

[ukstudent]

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?

Why is it so bad? If you clean the port first, the pump is turned off/put on standby, what makes it so bad? The IV tubing that we use does not use clips, which means that when you disconnect you can either let it swing free in the air, place a needle (sharp) on it or loop it. Of the three, looping, with the use of alcohol swabs, is the safest for both the patient and myself.

So again, is it the lack of cleaning that makes it unsafe or is there something wrong and unsafe about looping even with cleaning?

[Jolie, BSN]

I'm probably going to sound really outdated here (which I am), but my question is why are IVs being disconnected so often? Granted I worked with neonates who are much easier to move around and clean up, and they don't get up to the bathroom, but why not just bring the IV pump and/or pole with the patient? It seems to me that the real infection control issue is repeatedly disconnecting and reconnecting the IV line.

[sailgurlie]

If you have read any of the current research on biofilm, you know it only takes one "bug" to get a whole mess growing inside the patient. Many well recognized IV therapy experts also recommend to NOT disconnect as often as we do. It has become commonplace and does increase the potential of infection. Just because we can do something doesn't mean we should... based on public reporting laws and third party payors starting to not reimburse for infections there will be greater focus than ever on our practice- thus it must be best practice, all the time. :smilecoffecup:

[cardiacRN2006, ADN, RN]

I'm probably going to sound really outdated here (which I am), but my question is why are IVs being disconnected so often? Granted I worked with neonates who are much easier to move around and clean up, and they don't get up to the bathroom, but why not just bring the IV pump and/or pole with the patient? It seems to me that the real infection control issue is repeatedly disconnecting and reconnecting the IV line.

Sometimes people loop when the pt is getting up to go to the bathroom and the tech does it rather than go get the nurse. Sometimes it's done when the it's an IVPB and only get run every few hours.

I do it (and no, it's not sloppy or lazy) when I am dc'ing a certain gtt that I don't want left on. Like insulin or dopamine. Something I want off the pt but may put back on depending on pt progress.

To all the nurses who say it's 'lazy'...no one has ever addressed my points....

How is this any different then plugging in 2 or more compatable meds into the same line?

How is this port that the tubing is being looped into more or less dirty than the heplock?

Again--not lazy, not sloppy. It's fine, and not a safety issue at all.

[merellis2009]

At our hospital, we've been told that looping is an unacceptable practice and we could get written up for doing so. They've encouraged us to use a new sterile redcap on the end of the line any time we need to disconnect the patient (and have instructed us to try and disconnect as little as possible to avoid those bugs). Our nurse educator said that although theoretically, looping is still "sterile", anytime we connect/disconnect, it allows a new opportunity for bugs to come in, regardless of how well you clean the port. Not taking sides here, but just passing along what our facility does....

[LACrn]

At our hospital, we've been told that looping is an unacceptable practice and we could get written up for doing so. They've encouraged us to use a new sterile redcap on the end of the line any time we need to disconnect the patient (and have instructed us to try and disconnect as little as possible to avoid those bugs). Our nurse educator said that although theoretically, looping is still "sterile", anytime we connect/disconnect, it allows a new opportunity for bugs to come in, regardless of how well you clean the port. Not taking sides here, but just passing along what our facility does....

This really is the only acceptable method to store tubing. The looping method IS "lazy" and 90% of the nurses who do it DO NOT wipe the port with alcohol before storing it in this manner. In our facility any tubing found stored in this manner is to be considered contminated and discarded. A new sterile cap is the appropriate way to store tubing for intermitent use!! I would venture to guess that if techs are d/cing infusions just for the patient to go to the bathroom, the ports are NOT being adequately "disinfected" prior to storing.

[AprilRNhere]

I see nothing wrong with looping...but now my question is why are pt's being disconnected so frequently? A few here have made comments about pt's turning in bed, or being toileted. We only loop when the dr. has ordered a lock...but they have IV abx q 12 or 24 hours.

I agree that it's the cleaning that matters. If the nurse isn't cleaning...looping doesn't matter...their practice does.

[AprilRNhere]

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!!

http://www.ismp.org/Newsletters/nursing/Issues/NurseAdviseERR200711.pdf

This article says nothing about looping..it simply says you should not leave it hanging in the air.

[UM Review RN, ASN, RN]

Wouldn't that be the same as keeping a secondary line hooked up after the infusion was finished? I see that all the time, now that you mention it, so now you've all got me wondering if that's ok. I was taught that it was, so why is looping different?

[iluvivt, BSN, RN]

unfortunately the use of needleless systems has caused a few problems (not that I would ever want anything else). One of these problems is looping. We too have had a problem with this practice. We see nurses not scrubbing these ports and looping out of convenience. We have been teaching the nurses not to to this. These ports are for injection only. The end of any disconnected IV tubing should have a sterile end on it and every IV company makes them!!!!!. Every single time you use an IV system there is a risk of introducing micoorganisms into the system why increase that risk with this bad practice. INS knows what they are talking about and their practice standards hold up in court.

[GRANNAS4]

While many see nothing wrong with looping--consider, Many nurses do not or improperly cleanse the hub before insering the tubing end or the connector. The recommended cleansing is using an Alcohol prep vigorously wait for it to dry and then repeat. Please read this short article. http://www.ismp.org/newsletters/acutecare/articles/20070726.asp.

Looping is NOT standard of care. It is outlawed in our hospital.

[salpal92]

OK, maybe I am old school, but I was trained, (and practiced), not to disconnect patients/clients from their IVs. I have threaded IV bags through arms of clothing etc. Then only way to maintain "sterility" in NOT to open the connection, Keeping a "closed system" so to speak.