UAC line question

BittyBabyGrower, MSN, RN · Apr 17, 2009

You should not have a syringe on your line at all, you should be using a closed system. You can go to ihi.org and search for central line bundles, we use this for all central lines and UACs.

nicu4me · Apr 17, 2009

I read this post and went to the ihi.org site and couldn't find anything specific to NICU and UAC/UVC. When the above poster writes that there shouldn't be a syringe there at all, I wonder what you meant. If I could describe ours, we have the yellow cap that you would disconnect and zero the transducer with. The second is the three way stop cock with two ports open one has a cap also but the other has to have a syringe attached to it at all times. Such as a your 1/2, 1/4 NS or your medline. Not sure what you use at your facility. All the tubing filters/stopcocks, etc. are changed q 24 hours.

texas2007, BSN, RN · Apr 19, 2009

I think we change our stopcocks along with the whole UAC fluid tubing q 72 hours.

We trialed one of those closed system UAC lines and it was a disaster. Maybe it was just the particular one we tried but it just so hard to pinch here, push there, pull here. It seemed like it needed 3 hands to flush the line. Then (maybe since I was having issues) the pressure gradient got off and the UAC started bleeding back and after getting 3 RN's to come help, it turned out we had used up 1/2 the heparinized fluid trying to not have the UAC clot off and clear the line out (luckily it was a bigger kid). Sigh. Like I said...it was an utter disaster. I think we only trialed it on 2 patients and I never saw it again.

BittyBabyGrower, MSN, RN · Apr 20, 2009

We use the new Biosensors on our line. And you have to look under central line bundles...it doesn't matter if it is an adult or neonate, it is the same guidelines. We never even had syringes on ours when we used the regular setups. We always put an infusion plug in the ports , therefore it is a closed system. We found, during blind audits with both systems, that people were sloppy when syringes were left on there, ports weren't cleaned, etc. When they are capped off, people are more aware of having to clean all the ports before entering them,and it is always with a clean syringe. Our current system has a flush syringe on it, but it does not come off. We change everything every 72 hours.

NicuGal, MSN, RN · Apr 20, 2009

We recently went to the Biosensors also...they aren't too bad and are a closed system, which is nice.

When we had syringes, if they had blood in them, you had to change them out...blood is a great medium for bacteria. And people have to be very careful about cleaning all hubs before and after!

We change our lines every 72 also.

I agree with not having syringes hanging off stopcocks, esp flush syringes that aren't part of a closed system...most flushes, esp the prepackaged ones, are one time use only and should not be left on anything and used again.

SteveNNP, MSN, NP · Apr 20, 2009

I've used biosensors before, and hated them. Hate priming them, and hated the fact that you could easily bolus a baby with way too much saline and heparin without realizing it. As long as you are putting a sterile 4x4 under the stopcock and use aseptic technique, your infection rates shouldn't go up.

We change our stopcocks and transducer tubing q96h. We rarely use UACs unless the baby is a cardiac, or is on pressors. Never routinely.

NicuGal, MSN, RN · Apr 20, 2009

We havent' had any problems with the biosensors, and I don't see how you could accidently bolus a kid, it can't free flow because of how the stop cock is set up. And we have had no line sepsis since we instituted them. We will use the one part on central lines if we have a lot of draws, it is very easy to use. No stopcocks for people to leave syringes hanging off of and it makes them more conscious of cleaning the port.

SteveNNP, MSN, NP · Apr 20, 2009

We havent' had any problems with the biosensors, and I don't see how you could accidently bolus a kid, it can't free flow because of how the stop cock is set up. And we have had no line sepsis since we instituted them. We will use the one part on central lines if we have a lot of draws, it is very easy to use. No stopcocks for people to leave syringes hanging off of and it makes them more conscious of cleaning the port.

Since there is a 10-12ml syringe full of flush attached, anyone can unconsciously flush with an excessive amount, as opposed to flushing with a max of 1-3 ml. I had a baby who got almost 12 ml of hep/saline before the RN realized she had flushed that used the entire syringe of flush. The kid needed lasix for fluid overload and acute respiratory decompensation. We sometimes forget that 12 ml can be almost 20ml/kg of fluid for little ones.

You don't have to leave a syringe attached to the stopcock. We attach a prn adapter to the stopcock and swab it before drawing back.

NicuGal, MSN, RN · Apr 22, 2009

wow...in my opinion, that nurse was negligent. You can't tell me that she didn't know she flushed that whole big syringe into the kid..that is operator error, it has nothing to do with the product itself. And if any syringe is attached to a line, that can happen. We don't draw up the whole syringe from the flush bag, we only put 5ml at a time.

NeoNurseTX, RN · Apr 22, 2009

We use syringes and at 3 NICUs, I've never seen a closed system.

PrudenceNurse · Apr 25, 2009

RE: PICCs, Broviacs What skin antiseptic do your units use for placement of these central lines? What antiseptic is used for line changes? How often do people change fluids and tubing for central lines?