Infusion Equipment
Add-on Devices
Policy
When an integral in-line administration system is unavailable, add-on devices may be required to facilitate the delivery of the prescribed therapy. Limit use of these devices due to the risk of contamination from manipulation, accidental disconnection, or misconnection.
Add-on devices (eg, extension loop/sets, filters, manifold sets, blunt cannulas, needleless connectors, stopcocks) will be:
Attached aseptically and changed in conjunction with the administration set
Changed immediately upon suspected contamination or upon a break in integrity
Needleless connectors are changed if there is blood or debris visible within the needleless connector, upon contamination, prior to drawing a blood culture through a catheter, and routinely as established by the organization.
Procedure
Perform hand hygiene.
Don gloves.
Prime add-on device according to manufacturer’s directions for use (see Administration Set Change).
Remove existing add-on device.
Disinfect catheter hub/access port with antiseptic solution.
Attach new, sterile add-on device to catheter hub/access port.
Flush and lock catheter or initiate infusion, as appropriate.
Discard used supplies.
Remove gloves.
Perform hand hygiene.
Bibliography
American Nurses Association [position paper]. Safety Issues Related to Tubing & Catheter Misconnections. http://www.nursingworld.org/position/practice/tube.aspx. Accessed February 13, 2010.
Association for Professionals in Infection Control and Epidemiology (APIC). Guide to the Elimination of Catheter-related Bloodstream Infections. Washington, DC: APIC; 2009.
ECRI Institute. Needleless connectors. Health Devices. 2008;37(9):261-283.
Hadaway L, Richardson D. Needleless connectors: a primer on terminology. J Infus Nurs. 2010;33(1):1-11.
Jarvis W, Murphy C, Hall K, et al. Health-care associated bloodstream infections with negative- or positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis. 2009;49:1821-1827.
Menyhay S, Maki D. Disinfection of needleless catheter connections and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol. 2006;27(1):23-27.
Mermel L, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update. Clin Infect Dis. 2009; 49:1-45.
The Joint Commission. Tubing misconnections: a persistent and potentially deadly occurrence. Joint Commission Sentinel Event Alert. Issue 36, April 3, 2006. http://www. jointcommission.org/assets/1/18/SEA_36.PDF. Accessed December 9, 2009.
US Food and Drug Administration. 2009 medical device safety calendar on luer misconnections. http://www.fda.gov/medicaldevices/Safety/AlertsandNotices/ucm134863.htm. Accessed on August 8, 2009.
Filters
Policy
Filters are used to prevent the passage of undesirable substances into the vascular system. The specific type and size of filter used is determined by the infusate and may be an add-on device or an integral part of the administration set.
Filters are applied and changed, coinciding with the administration set change.
Blood and blood component filters are changed every 4 hours or coinciding with blood administration set changes.
A 0.2-micron filter that is bacteria- and particulate-retentive and air-eliminating is used with nonlipid-containing solutions that require filtration.
A 0.2-micron filter that is surfactant-free, particulate-retentive, and air-eliminating is used with intraspinal infusions.
A 1.2-micron filter that is particulate-retentive and air-eliminating is used with lipid infusions or 3-in-1 parenteral nutrition.
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