I will add that even with the use of a closed system device some systems require flushing to prevent exposure. We are currently converting from Spiros to PhaSeal and during training learned before disconnection the closed system PhaSeal device must flushed to clear the connection of hazardous drug. This caused us to rethink and retrain several processes in our nursing staff; something that was not considered by pharmacy when they decided to make the change in products.
Michelle Payne MSN, RN, OCN, BMTCN Nurse Educator
7CC West BMT and 7CC East Hem/Onc Medical Center Boulevard \ Winston-Salem, NC 27157 p 336.713.7694 \ f 336.716.5399/ pager 6815 firstname.lastname@example.org \ WakeHealth.edu
We place a CTSD at the end of all of our lines. We use Equashield and love the product. The pharmacy attaches the female adapter to the end of all of the chemotherapy primed lines. The oncology nursing staff attach the male adapter to the peripheral J loop and Huber needle adapters. It is standard to flush with normal saline 10mL pre-filled syringe after each drug is administered to prevent mixing of medications, a normal saline bolus from the IV bag does not offer enough pressure (even at 999mL/hr) to get the medication out of the luer activated valves in the primary tubing. I hope this helps.
Laura Muller BSN, RN, CPUI, OCN
Director of Oncology & 1 South Clinics
615 Fulton Street
Port Clinton, OH 43452
T- 419-734-3131 ext. 3344
T-Direct Line 419-301-4352
We use CSTD at the end of the primary line. For the reasons you stated above and the unpredictability of kids and their curious fingers. Most recently I have used the Phaseal devices, and even though it is big and bulky, we don't tend to have any problems. And surprisingly, most kids leave them alone. (There is a cover that can be put over the device to help secure it from being pulled apart, but we rarely have to use that.)