Great question. I’m not sure if the evidence exists yet to answer this question fully. This could be a research question for our academic colleagues. However, I do have a few thoughts. If it is for blood cultures I would definitely remove the needlefree connector. Standard blood tests I would keep the needlefree in place. However, I would flush effectively to clear the device of any blood residue.
We are more than happy to leave peripheral cannula in place and remove when clinically indicated. However, the bigger issue is the drug and the type of device. When using drugs that are known to cause chemical phlebitis why wait until the phlebitis occurs? If phlebitis is likely and the length of treatment is long enough then longer term vascular access devices should be considered.
I asked the same question about the potential for coring when using blunt fill needles. I was told by a company representative that the blunt fill needles are designed not to core the rubber. We happily use the blunt fill needles for rubber stoppers and the blunt filter needles for glass. It must be close to a year since we started widespread use. No evidence of problems… and I would have been informed!
I wrote a very small article (heavily edited by the journal)… not a match on Debbie’s article… but parts may be useful.
Jackson, A. (2007) Development of a trust-wide vascular access team. Nursing Times. 103(44), p.28-29.
This article explains how a dedicated organisation-wide vascular access team was developed at The Rotherham NHS Foundation Trust, a single-site district general hospital trust serving a population of just under 250,000. It outlines the aims of the project and improvements in clinical standards as a result of setting up the vascular access team. It also identifies areas for future improvements.
Counting is good. I would also add that I have found the team approach beneficial to patients, staff and the organisation as a whole. When you count, outcomes must demonstrate the impact on these three groups. You must also have ready your response to the standard question ‘will a team de-skill the existing workforce’. My answer was to produce a team that a) provided clinical care at the greatest point of need, b) was responsive and timely, c) diplomatically dealt with knowledge awareness across the whole workforce and d) emphasised that the team would teach and promote best practice standards throughout the organisation.
Great question Matt… however, an evidenced based answer is unlikely!
Working almost everyday on the materials published on IVTEAM I have the opportunity to review many infusion and vascular access publications. Even the publications that specifically look at peripheral IV catheter dislodgement are difficult to apply to all global IV clinical situations. The different type of vascular access device, method of securement and type of use (e.g. push injection, intermittent infusion or continuous infusion) are just some of the variables that may influence outcomes.
However, from my experience I can say that a short extension and needleless device appears to reduce the side to side ‘pendulum’ effect that is often seen with peripheral IV catheters as they are used. Of course, additional benefits include an ability to clean the access port and clamp under positive pressure.
To summarise, short extensions with needleless connectors appear to reduce movement of the vascular access device underneath the dressing, allow an aseptic technique to be followed and ensure the device can be ‘locked’ to prevent occlusion.
I am sorry that I cannot comment specifically on the port question. However, you may find my comments re PICCs useful. My clinical experience (UK) is with radiographers in CT departments accessing CT rated PICCs. They are a highly educated professional group who have received the appropriate accessing PICC training and continue to maintain experience on a regular basis.