Should we change the needleless hub after drawing blood from a central catheter?

[Probably, BSN]

Hello,

A travel nurse recommended that I change the needleless hub after I draw blood from a central line. He simply said that the practice decreases the risk of CLABSI. Blood that remains in the hub can harbor bacteria and be introduced into the blood stream with subsequent use. Made sense to me. However, I can't find any research to substantiate this. What do you all know about this?

Probably

[CCU BSN RN]

We're supposed to change them every time we draw blood. But if I'm doing q1-2h blood draws...I'll just change it at the end of my shift. It's tedious and a waste of supplies a lot of the time, IMO.

[MikeyT-c-IV]

You'll get conflicting opinions depending on who you ask.

Some will say to flush the catheter with 20mL of saline after drawing your lab using the push pause technique. Changing the cap opens up the system which can also place your patient at risk for infection.

[Kuriin, BSN, RN]

Our facility requires you change the cap and then flush after drawing from a central line.

[NurseKatie08, MSN]

Post is a few months old, but just wanted to chime in (not an ICU nurse, but do draw from central lines). Our hospital policy requires to change the cap & flush with 20ml NS after each draw. In the med/surg units we are also limited to 2 draws per day from a central line (I believe to reduce CLABSI risk)...more than that requires a doctors order. The units can draw whenever required.

[MunoRN, RN]

Changing the cap after blood draws isn't supported by evidence or by recommendations, both the INS and CDC recommend changing caps every seven days. There are reports of organizations that have switched from changing caps after blood draws to only every 7 days that have reported reduced CLASBI rates as a result, although these were not controlled studies or large enough to like identify any variation in infection risk. Changing the caps unnecessarily often presents the opportunity to introduce bacteria at the cap/hub connection, without any benefit to offset that risk, so based on the net balance of risks, caps should not be changed after blood draws.

It is important to properly flush not just the cap but the entire line after drawing blood or checking for blood return, which includes the need to push/pause flush particularly for valved/displacement caps and lines.

[Greenclip]

We change the needleless connector/clave every 7 days. I have never heard of changing it after a blood draw. Our policy for blood cultures, though, if we're drawing off a central line, is to either draw directly from the hub or to put on a new connector and draw through it. Policy is also to change the connector if it has old, visible blood in it.

I think that an adequate flush after drawing is crucial. I've seen some nurses skimp on that. Given the length of the catheter, I think it's very important to flush with at least 10 cc of saline after every draw.

[nor-E-pine-phrine, BSN, RN]

We flush with 20NS. RNs only change the cap before cultures.

[ValeryRN]

Hi

We do not change the clave after blood draw. We change it every 7 days. Push/pause flushing with 20 cc NS after blood draw cleans the connector and catheter lumen.

[brap740, BSN, MSN]

I think the idea of changing after is to make sure they're changed so that when the next person comes along and draws and decides not to change the cap then it's already done. Seemed like a knee jerk reaction to fix a bedside problem from a suit. Doesn't work, and may actually lead to MORE clabsi.

Example:

suit RN: oh my golly, look at these clabsi rates?

CNO: how could this be?

suit Rn: well probably the caps are dirty!

CNO: how do we fix this ?

suit RN: NEW CAPS EVERY DRAW!!!

cno: I agree. Send out emails. Send someone to tell someone to tell someone else to tell the nurse manager who tells the ANMs to implement the new policy to the bedside nurses.

suit Rn: right away sir/ma'am! I will push this out ASAP!

****email after email. Meeting after meeting. Person after person informed all the way until we reach the bedside nurse*********

Bedside nurse: we have to do what now?

ANM: hey that's just what they tell me from above can't change it.

Bedside nurse:thanks for including me in your grand idea. See You next month..../sarcasm

And now do you see a disconnect from suits and bedside nurses? Would be nice if we could change that.

Back to the cap.....Research backs up once every 7 days. keeping a sterile closed system. Adequately flush and scrubbing the hub should keep the rates down.