The Vancouver Hospital Infusion Program
November 1999 Drug & Therapeutics Newsletter
(C) 1999, CSU-Pharmaceutical Sciences
Vancouver Hospital & Health Sciences Centre
The Reduced Needle System: Tips To Improve Use
The reduced needle system was introduced at the VGH and UBCH sites in September 1999. To facilitate this change, the Infusion Program coordinated over 230 inservices over a 24-day period and produced a "Hollywood North!" video for those who were unable to attend. Although the introduction of the reduced needle system has been successful, a few technique-related problems have been brought to our attention. These problems typically subside as experience is gained with the new devices. Some of the questions we have received include:
Question: Why do the upper and lower injection ports leak for some patients?
Response: This tends to be a technique-related problem. Too little pressure when connecting the ports of the primary and secondary tubing together can cause a loose connection and subsequent leakage. Too much pressure can cause connection damage and leakage. The correct method to connect the tubings is to:
Firmly insert the secondary tubing into the injection on the primary tubing. Do not twist the secondary tubing when inserting it and do not grasp the tubing collar during this step.
Finger tighten the secondary tubing collar once the secondary tubing is firmly seated.
Question: Can I needle through the injection port to administer drugs or flush the line?
Response: No. Needling through the port will damage the port (in particular, the back-check valve) and cause leaking. Luer-lock syringes are connected directly to the port. To administer drug products that are packaged in pre-filled syringes with fixed needles, an injection cap must be attached to the port.
Question: Why and when do I need to use a "dead-ender" cap?
Response: A dead-ender cap needs to be attached:
Whenever the original cap on the injection port has been removed. The reduced needle system ports are not self-sealing. Without a cap on the port, you have an open system!
To the end of a 7-inch extension on a peripheral IV.
Question: Why does blood sometimes back up into the 7-inch extension when it is used as a saline lock.
Response: This backup can occur when you have not clamped the extension tubing close to the IV site. Clamp as close to the IV site as possible using a positive pressure technique. The 7-inch extension tends to be bulky and we are currently investigating alternatives.
Question: On our unit we are continuing to use the T-piece for incompatible medications and needling through the cap. Is there a needleless T-piece available?
Response: Not yet, but we are also investigating this issue. We anticipate having an alternative by February 2000.
Question: Do we use the reduced needle system procedures for CVCs?
Response: No. Refer to the existing patient care guidelines for CVC procedures. We anticipate modifying the guidelines by February 2000.
Contact one of the Infusion Program educators (Lynn Chase, Carole Leong, Ruth Nicol, Sally Tomlinson) at 54706 if you have any questions regarding the new tubing.