Blood & Marrow Stem Cell Transplant

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Central line cap changes-do you change after transfusions

  • 1.  Central line cap changes-do you change after transfusions

    Posted 01-25-2019 15:59
    ​​How often do you change central line caps-is it when tubing is changed and does anyone change caps after a transfusion?  If so, what is the justification/evidence?

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    Joy Lombardi, BSN, RN, OCN
    Clinical Operations Dir.
    Huntsman Cancer Institute
    Salt Lake City, UT
    joy.lombardi@hci.utah.edu
    801-585-9822
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  • 2.  RE: Central line cap changes-do you change after transfusions

    Posted 01-25-2019 16:38
    Hi Joy,

    we change caps q week and PRN (if visibly dirty, blood not clearing etc) we also change cap before each blood culture draw.
    We do not change after a transfusion - my that would be a lot of cap changes.


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    Rebecca St Jean RN BSN
    RN, CNE
    Surrey BC
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  • 3.  RE: Central line cap changes-do you change after transfusions

    Posted 01-26-2019 19:12

    We are the same as Rebecca--weekly and PRN and before blood cultures.


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  • 4.  RE: Central line cap changes-do you change after transfusions

    Posted 01-26-2019 05:43
    At my hospital we change caps at least every 96 hours, with blood cultures and after transfusions (that was implemented about a year ago.) It is a lot of cap changes! We have consistently decreased our CLABSI rates over the past 5 years, so I can only assume that it is helping- among the many other things we do.

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    Amber Floyd RN BMTCN MSN OCN
    Registered Nurse, Senior Partner
    Indiana University Health
    Indianapolis IN
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  • 5.  RE: Central line cap changes-do you change after transfusions

    Posted 01-26-2019 06:20
    Cancer Care Services changes blue and white caps and all tubing on Monday and Thursday. Exceptions are made for TPN (should be changed every 24 hours), blood transfusions (change after one to two RBC transfusions, and we transfuse platelets hub-to-hub (no cap between tubing and lumen), then replace the cap), and stem cell infusions (also hub-to-hub). We do not change caps when drawing blood cultures. Except for these specific exceptions, we try not to change caps any more than 96 hours (or Monday/Thursday) due to infection risk.

    The rest of my facility/hospital does things differently, like changing caps with blood cultures. I believe Cancer Care Services does it a little bit different regarding blood cultures because of the rate of infection in our patient population (blood cancer and stem cell transplant patients), and how fast we implement neutropenic fever protocols and sepsis protocols.

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    Leslie Cowles, RN, BSN, OCN, BMTCN
    BMT Staff RN
    Presbyterian/St. Luke's Medical Center
    Denver, Colorado
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  • 6.  RE: Central line cap changes-do you change after transfusions

    Posted 01-28-2019 10:18
    No one has mentioned biofilm. That's the reason for needleless connector changes.

    The longer the connector stays in place, the more biofilm develops. There is a relationship between biofilm and microorganism growth. I don't have the references with me, but this has been well documented in the Journal of Infusion Nursing.

    For highly neutropenic patients such as BMT, conservative measures make sense. We also change ours at least 2x per week, with each blood draw per day and with cultures. We do not routinely change them with transfusions.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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  • 7.  RE: Central line cap changes-do you change after transfusions

    Posted 07-08-2019 13:38
    Seth,

    Do you have access to the article you are referring to?  I appreciate your feedback.

    Thank you.​

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    Dulcy Wilson, MSN-Edu, RN, OCN®
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  • 8.  RE: Central line cap changes-do you change after transfusions

    Posted 07-09-2019 15:06
      |   view attached
    Hi All,
    here is some information about bio film that was presented at the most recent INS conference.  Hopefully it uploaded & you can view it.
    thank you,
    Tina

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    Christina Klein MSN, RN, OCN, CRNI
    Oncology Educator
    Cancer Treatment Centers of America
    Philadelphia PA
    215-537-5586
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    Attachment(s)



  • 9.  RE: Central line cap changes-do you change after transfusions

    Posted 07-11-2019 21:30
    Hi
    The biofilm articles were published by INS several years ago. I don't know if I still have them but will let you know if I do.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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