Tubing Management

Tubing misconnections may cause serious adverse outcomes.

   Nursing Alert 
Tubing misconnections may cause serious adverse outcomes. This Clinical Practice Guideline is based on the Joint Commission Sentinel Event Alert. 

   INTRODUCTION: 

Outcome goals:

·        Protection of patients against medication occurrences due to tubing misconnections

·        Reduction of the incidence of tubing misconnections

 Purpose: To outline the nursing management of patients with multiple lines and tubings. 

Target audience: Nurses caring for patients with lines and tubings. 

Background: Tubing and catheter misconnection errors are an important and frequently under-reported problem in providing healthcare. Although these errors are often caught and corrected before an injury occurs, the potential for life threatening consequences warrants that healthcare providers develop an increased awareness regarding tubing/catheter-related patient safety. 

Patient population: Patients with IV lines, central lines, arterial lines, Swan Ganz lines, indwelling bladder catheters, enteral feeding tubes, NG tubes, oxygen, ventilators, epidural catheters, and other tubings/catheters used in administering therapeutic interventions.

 Definition of Terms:

Tubing misconnection – the inadvertent cross connection of a patient’s tubing or the addition of a tubing or connector to a wrong line/tubing.  Examples of the types of misconnections that may occur include the following:

IV infusion connected to epidural line or epidural fluids connected to an IV or central line
Bladder irrigation solutions using primary IV tubing connected as secondary infusions to a peripheral or central line
Infusions intended for IV administration connected to indwelling bladder catheter
Infusions intended for IV administration connected to nasogastric tubes
IV solutions connected with blood administration sets and blood products transfused through primary IV tubing
Enteral feeding to a central venous catheter
Noninvasive blood pressure insufflation tube to a needleless IV port
Oxygen tubing to a needleless IV port
 Luer lock fittings and connectors – small devices used to connect many medical devices, components and accessories.

·        A luer slip connector consists of a tapered “male” fitting that slips into a wider “female” fitting to create a secure connection. 

·        A luer lock connector has a threaded collar on the “male” fitting and a flange on the “female” fitting that screw together to create a more secure connection.

ASSESSMENT

1.      Complete a thorough nursing assessment upon admit, including all devices, tubings and lines.

1.      Reassess all devices, tubings and lines upon the patient’s arrival to a new setting or service as part of the hand-off process.    

2.      Always trace a tube or catheter from the patient to the point of origin when assuming care (ex. shift change, transfer) of the patient.

 TUBING MANAGEMENT

1.      Always trace a tube or catheter from the patient to the point of origin before connecting any new device, infusion or medication.

2.      Recheck connections and trace all patient tubes and catheters to their sources upon the patient’s arrival to a new setting or service as part of the hand-off process.  

3.      Label high-risk catheters and lines (epidural, intrathecal, arterial, etc.).

4.      Avoid using a standard luer lock/slip connector whenever possible.

 SAFETY TIPS

1.    Do not use a standard luer syringe to administer oral medication. Use only an oral medication syringe when giving oral medications. 

2.    For patients with multiple IV lines, consider using a line organizer.

3.    Inform all non-clinical staff that they must get assistance from clinical staff whenever there is a real or perceived need to connect or disconnect devices or infusions.

 DOCUMENTATION

Assessment of devices, tubings, lines, and catheters should be documented using the appropriate HIS or SIS screens and/or flowsheets.

 PATIENT/FAMILY EDUCATION

Inform patients and their families that they must get assistance from clinical staff whenever there is a real or perceived need to connect or disconnect devices or infusions.

 COMMUNICATING PLAN OF CARE

Communication of individualized plans of care will vary according to patient population/units, types of tubings, and may include methods such as shift report and/or written care directives.

 

 

 

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