Even in the past few years, there have been reports of CRBSI using needleless connectors in hospitals in a long-term care facility compared to six randomized controlled clinical trials of Eu ropes performed between 2000 and 2007. , CRBSI did not increase the pinless connector, three of which studied the pinless connector will reduce the CRBSI rate. However, there are significant differences between the two. In the United States and in European studies, where the latter has been followed, researchers have compared "traditional open systems" (that is, placing stopcocks at the end of each catheter joint ) And positive displacements of connectors containing negative or negative pressure mechanical valves. Patients are randomly signed and placed on each opening of the plug valve individually using a plug valve or a needleless connector. In the United States, a stopcock is commonly used, but during anesthesia and intensive care (when placed) in a continuous infusion intravenous group rather than directly connected to a catheter hub. In the United States, as the accumulated experience of nurses overcomes the challenges of using the new needle-free system, it appears that infections are becoming less common. The CDC guidelines stated in 2002 that "the needleless connector affects the incidence of CRBSI when used according to the manufacturer's recommendations." However, many subsequent reports of CRBSI outbreaks have used the needleless system. 5, 9 In 2008, the United States Medical Epidemiology published a series of strategies to prevent hospital CRBSI. They recommend the use of needle-free connectors before a thorough risk assessment, as well as the proper use of positive pressure needle-free connectors with mechanical valves. New disinfection technology. Recently, a new technology, the Site-Scrub isopropanol unit (Bard Access System), was used to clean the pinless connectors. A hard plastic cover with a little finger like a sponge and saturated with 70% isopropanol, the device can be placed on a needle-free top connector, a plug valve or a catheter connector. Rotating the lid allows the sponge to clean surfaces, including lumen surfaces of cocks or catheter fittings.
Clinical studies of the device are ongoing and found to be unavailable.
Another device in this category is an infection or protective cap. SwabCap (Excel siorMedical), Curos Port Protector (Ivera Medical), EffectIV-Cap (Hospira), and DualCap (catheter connection) are rigid plastic covers that contain a
Round sponge filled with 70% isopropanol. They are placed on the pinless connector and allowed to stay in place until next use. Alcohol saturates surfaces and kills living things. The lid remains in place between uses to prevent environmental pollution. A recent clinical study of protective caps used around the serrated central catheter (PICC) found that intraluminal contamination was significantly reduced and the density of bacteria was reduced. 32A 2012 before and after research on these protection caps showed that CRBSI was significantly reduced. Infection rate decreased from 2.3 per thousand catheter days to 0.3 / 1000 during manual scrubbing
Catheter days during use of protective caps33 These protective caps clean the connection surface so that no initial scrubbing is required, but they are not intended to replace all scrubbing needleless connection surfaces. A single drug may require three or four connections and disconnections. Therefore, although the first scrub can avoid the use of this tool, all other accessories of the kit or syringe should be secured before thoroughly scrubbing the surface.
Catheter lumen blocked. Early on, nurses suspected that the demand for thrombolytic agents in hospitals was increasing. Patients receiving intravenous therapy with components using large blunt cannula and internal moving mechanical valves. Evidence of catheter lumen obstructions related to needleless connectors is limited to continuous cohort studies and two randomized clinical trials. Positive displacement connectors were developed to address the issue of occlusion. Only recorded during the test
Controversy over flushing and locking practices.
Catheter lumen obstruction may be associated with improper irrigation and locking techniques. All VADs used must be flushed and locked after each use. Catheters should be flushed with a 0.9% sodium chloride (saline) solution to assess patency to prevent incompatible drug contact. Locking the catheter creates a line of fluid in the lumen to keep it open. Positive, median displacement needleless manufacturer connectors instruct clinicians to use a saline lock catheter rather than a heparin lock solution. However, the clinical evidence for this approach is limited. Two recent studies found that lumen occlusion increased when locking with saline solution. In one of the studies, 6% of the occlusions
Ratio related to normal saline lock (relative to 0% heparin salt solution occlusion rate makes it financially infeasible for hospitals to eliminate heparin use. Given the cost of each PICC replacement, salt lock is $ 1,900.34. A recent systematic literature review compares maintaining central Clinical study results of unobstructed venous catheters Heparin, saline or urokinase flushing; continuous heparin-coated heparin-coated catheters; or "pressure caps"
(No pin connector with positive displacement). It was concluded that published studies comparing interventions to prevent obstruction were "very low quality" and that the current evidence is insufficient to support any way to keep things open. Because heparin is incompatible with many drugs, all VADs require the use of a link between the competent saline administration to prevent the formation of deposits in the contact cavity. A meta-analysis of two studies involving short-peripheral catheters found that catheter outcomes were actually due to these reasons, and the 2011 Standards for Fusion Care Practice recommended the use of saline as a locking solution. However, due to the risks associated with the insertion of a central venous catheter, a higher level of support is required before a new version can establish standards of use. According to the National Practice Standard for Infusion Nursing Locking Solution (10 units per milliliter) according to the 2011 Standard for Infusion Nursing, in vitro studies show that heparin can enhance biofilm growth, but no clinical studies have confirmed heparin use The potential association with heparin increases the incidence of CRBSI. Use heparin-locking solution before we give up, more data is needed to get more results. Research properties combining anti-infective and anticoagulant alternative locking solutions are still ongoing, but these solutions are not currently available in the United States.
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