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Is it correct to remove needle free connectors prior to obtaining blood cultures?

We are looking at reducing contaminated (false positive) blood cultures. One particular approach that we are suggesting is the removal of needle free devices prior to the collection of blood cultures from central venous access devices. Can anyone suggest any published evidence or guidelines that support or refute this approach?


In: phlebotomy, Posted 5 years ago

By: Level Rating Level Rating10 points

3 Answers

Answer #1

The use of needle-free devices (NFD’s) is designed to reduce the risk of contamination. The one key factor/variable for all NFD’s is how well the key part (membrane) has been cleaned prior to access.

Some NFD manufacturers recommend changing the device after blood taking (so check your instructions for use).

Epic 3 recommend cleaning NFD’s for a minimum of 15 seconds, however do not state a drying time, and the drying time(or kill time) is as important as the cleaning time. I would suggest asking the manufacturer of the cleaning pads and NFD what they recommend for the cleaning and drying time.

Darcy Doellman(BSN, RN, CRNI) looked at the importance of NFD cleaning in some detail (The Role of Technology in Reducing Risks Associated with CRBSI). West Virginia University Hospitals showed ‘There was a significant reduction in the percentage of contaminated blood cultures drawn from central venous catheters from 2.5 to 0.2’ by reducing the variation in cleaning practices when sampling from a NFD’s, this was presented in the ‘Impact of Alcohol Impregnated Port Protectors and Needleless Neutral Pressure Connectors on Central Line-Associated Blood Stream Infections and Contamination of Blood Cultures in an Inpatient Oncology Unit.

I hope this information has been of use. I would be happy to discuss this important subject of NFD cleaning further with anyone that feels this needs to be addressed.

My direct email is luke.rawlinson@vygon.co.uk

Answers Answered By: luke.rawlinson Level Rating1 points
Answer #2

Thank you for your answer. I agree completely with your comments re cleaning intraluminal access points. However, the question with regard to blood cultures was associated with false positive results when cultures are obtained.

I assume your comments are that if NFD’s are cleaned correctly then contamination of the blood culture will not occur. This may be the case, however, if the internal mechanism of the NFD is contaminated will this increase the chance of false positive results? I’m guessing its a big research study in waiting 🙂

Answers Answered By: ivteam Level Rating10 points
Answer #3

Really interesting question. If you consider the iv connector to be the door or gateway to the catheter – and subsequently part of the catheter, it would seem illogical to remove the door – so to speak.If you remove the iv connector then you are opening what should be a closed system. It certainly needs a good study to review the topic.In the meantime clinically I would not remove the iv connector but be very certain that disinfection and drying time are followed to the letter.I believe that the design of the IV connector does have a part to play in the ease of disinfection which ia another variable that should be taken into consideration

Answers Answered By: sheilainwood Level Rating2 points

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