The hospital’s policy about cleaning catheter hubs and needleless connectors recently changed due to the serious concern about central line associated bloodstream infection. There is now a great emphasis on cleaning the luer-locking threads of the female catheter hub before applying the new needleless connector. All nurses have been instructed to wrap an alcohol pad around the catheter hub and rotate it several times and then allow it to dry. Four days later it is now time for you to change the needleless connector, and it simply will not come off. Try as you might, it will not budge. Your only thought is to get a hemostat to hold the catheter hub and maybe a second hemostat to hold the needleless connector and twist. But even that does not work! Why did this happen and what do you do?
First, where is the evidence for this type of cleaning on the catheter hub? In the 1990’s there were several articles pointing out the catheter hub as the pathway for organisms to enter the bloodstream. But there were no studies then, or now, examining the methods for doing this type of cleaning. Remember 25 years ago, we were not focusing on the catheter hub like we are now. Many hospitals have adapted this practice of hub cleaning even without research to assess the outcomes of the practice. There could easily be dried blood, drug precipitate and skin oils contaminating the catheter hub and this debris could easily enter the catheter lumen.
The needleless connector could be permanently fused to the catheter hub because of the type of plastics being used in those devices. Thermoplastic polyurethanes are a common type of material for these devices but there can be many different types within this group. Strength and durability are great characteristics, but some types can not tolerate exposure to alcohol. Both ethanol (the kind used for drinking and IV fluid) and isopropyl alcohol (the common disinfectant) can soften the plastic. Sometimes even allowing the alcohol to thoroughly dry is not enough but this could be the problem. The soften surface of the catheter hub could leave the used needleless connector permanently attached. There may not be any method for removing the needleless connector.
One word of caution, use of hemostats can easily cause the catheter hub to crack and leak. This could provide any entry for organisms into the lumen. A needleless connector that can not be removed or the cracked catheter hub could require the insertion of a new catheter.
Before instituting this cleaning policy, check the details in the instructions for use (the booklet inside the package of all central venous catheter packages) about use of alcohol on all parts of the catheter, including the hub. Some have a specific statement about cleaning the hub with alcohol. Others have warnings about use of alcohol for skin antisepsis, instillation of ethanol for clearing occlusion from the catheter lumen, but there may not be any statements about applying alcohol to the catheter hub. For more information about your issue, call the catheter manufacturer’s clinical information department.
For anyone interested in the details of thermoplastic polyurethane, look at this YouTube video. But, be warned, this video is very technical about polymer science.
Visit our website to learn more about online courses and video conferencing.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.