Use of T-Connectors/IV catheter protocol

RE: Use of T-Connectors/IV catheter protocol

V E S — Fri, 23 Mar 2018 21:28:35 GMT

- would be closer access to IV with our current giving sets

- No way am I carrying anything clinical between my teeth!

- When drips aren’t running and not in a pump I have found they get blood flow up in the giving set, but never found this with extension lines.

-Because of the way extension sets are attached/taped to animal they pull less on the catheter, is what I meant!

-I think the risk is minimal, given needle free systems and also the amazing sterets!! We flush lines anyway so that wouldn’t incur too much of an extra cost.

All is nurses would like them for ease, I just think the vets would appreciate some good evidence!

RE: Use of T-Connectors/IV catheter protocol

Alison Clare Hickman — Fri, 23 Mar 2018 19:14:11 GMT

euwww apache

Yuck. "that's why God gave you teeth"... Seriously?!?!

RE: Use of T-Connectors/IV catheter protocol

jojofruits — Fri, 23 Mar 2018 15:52:12 GMT

I would imagine much of the evidence would be cited in articles for human nursing no?

I've never looked it up but practically I find t connectors essential and always use them.

RE: Use of T-Connectors/IV catheter protocol

James Colver Cert. Ed, RVN — Thu, 22 Mar 2018 23:45:23 GMT

At our practice we frequently have cause to add in other infusions, and we use needle-free sets. A T connector is an indispensable way to piggyback in another line without having to disconnect at the cannula.

There isn't less weight on the cannula but there seems to be less drag (depending on one's method of securing them) and less inclination to kink.

RE: Use of T-Connectors/IV catheter protocol

apache — Thu, 22 Mar 2018 22:56:54 GMT

[quote user="Victoria Stearman"]Closer access to IV,[/quote]

Depends on your giving sets, but I had a measure and there is very little in it.

[quote user="Victoria Stearman"]taking patients out of kennels (trying to get a cat out that had a u-cath in situ and trying to carry its fluid bag all at the same time is extremely difficult, I’ve learnt !!!)[/quote]

That's why god gave you teeth.

[quote user="Victoria Stearman"]preventing blood backflow[/quote]

How so?

[quote user="Victoria Stearman"]Less weight on IV catheter[/quote]

I think you must mean more weight as there is still the same giving set attached plus a T-piece.....

You need to address the risks of contamination from disconnecting the drip. Balance the additional costs including flush. Risk of air embolus (can't happen in a closed system with a collapsible bag). Extra faff and complication......

RE: Use of T-Connectors/IV catheter protocol

V E S — Thu, 22 Mar 2018 22:44:18 GMT

Thanks the extension line in the picture is what I was referring to when I said t connectors!

I just would like some evidence to present to the head vet to help me introduce them. (I’m a fan of a good article!) Nurses have tried to convince them before and it hasn’t happened. I swear by them, I was in referral for 2.5yrs so am desperate to get some!

I thought that the main pros so far are;

Closer access to IV, taking patients out of kennels (trying to get a cat out that had a u-cath in situ and trying to carry its fluid bag all at the same time is extremely difficult, I’ve learnt !!!), preventing blood backflow, Less weight on IV catheter , etc I could go on!

RE: Use of T-Connectors/IV catheter protocol

Ben Ogden — Mon, 19 Mar 2018 23:04:33 GMT

“What really annoys me is when something like this gets published and then in 10 years time someone swears blind that 3 is the magic number and no one knows where that ever came from.” This is the example of subscribing to a flat earth. It’s the same as the “we’ve always done it this way”, but cannot reason why. It isnt beyond the realm of possibility to ask for the underpinning knowledge that backs an opinion, even if the consensus considers it common sense. Case and point, the misnomer about cats and the sweet taste of antifreeze... I’ll step off this thread because I’m derailing it from the OPs original request for info, but if anyone wants to go further into it, you can PM me.

RE: Use of T-Connectors/IV catheter protocol

James Colver Cert. Ed, RVN — Mon, 19 Mar 2018 19:17:42 GMT

[quote user="Ben Ogden"]

[quote user="apache"]

James, I do appreciate what you are saying and in the absence of quality evidence then people's opinion may be the best we have. I still think the advice would be much better if we were given at the very least a link to the science behind the recommendation or an acknowledgement that no one knows and we believe this is reasonable. What really annoys me is when something like this gets published and then in 10 years time someone swears blind that 3 is the magic number and no one knows where that ever came from. If you look at the human NICE guidance its well referenced and clear what is supported by science and what is personal opinion.

As nurses and vets practising evidence based medicine this is really important.

[/quote]

THIS!! This drives me up the flipping wall!!

It's also the reason why I've been kicked out of Vet Nurse Chatter on Facebook for the third (and indeed last) time, because I call out people that have an established opinion on a subject, but no data to back it up. Telling me it's gold standard and being unable to send me to credible data puts you in the same category as flat earthers.

Want to be treated, respected and paid like a professional? Start behaving like one, by not basing your opinion on opinion or superstition.

[/quote]

So what protocols do we follow when there is a lack of evidence (which is the case for so much of what we do?) Are the opinions of people like Louise O' Dwyer who helped put these guidelines together worthless?

Regarding the original question, and others like it, would "There is little evidence on the subject, so do as you please" have been a better reply than "Here are some carefully-considered and sensible guidelines put together by a bunch of people who spend their lives studying this stuff?" - nobody is saying that EB shouldn't be used when it's available, but half the time, it isn't. Perhaps someone else could offer the OP a better response to the question when everyone has finished being so magisterial.

There is a difference between using common sense in the absence of evidence, and subscribing to the idea that the earth is flat.

RE: Use of T-Connectors/IV catheter protocol

Susanna Taylor — Mon, 19 Mar 2018 15:30:49 GMT

[quote user="Ben Ogden"]

THIS!! This drives me up the flipping wall!!

Want to be treated, respected and paid like a professional? Start behaving like one, by not basing your opinion on opinion or superstition.

[/quote] Who or what are you referring to Ben Ogden?

RE: Use of T-Connectors/IV catheter protocol

Ben Ogden — Mon, 19 Mar 2018 12:40:13 GMT

[quote user="apache"]

As nurses and vets practising evidence based medicine this is really important.

[/quote]

THIS!! This drives me up the flipping wall!!

Want to be treated, respected and paid like a professional? Start behaving like one, by not basing your opinion on opinion or superstition.

RE: Use of T-Connectors/IV catheter protocol

Susanna Taylor — Mon, 19 Mar 2018 01:11:12 GMT

I’m not a fan of traditional ‘T connectors’ BUT I always use a connector of some sort between the catheter and the drip. If only Tcons are available I’d use one every time.

Reasons being that it takes the tension off the catheter when the drip is pulled, and doesn’t risk kinks with taping. Also allows for the giving set to be replaced without touching the catheter, and gives an injection port right near the catheter so reduces amount of flush needed (important in small patients).

I prefer ‘end extension sets’ over t-connectors emensly. They are more flexible to secure and inject through. Infusions concepts and vygon are the places to look. Both also offer ‘needle free valve’ versions which means the system is kept closed when the drip is disconnected, and reduces needle stick risks. Win win.

I agree there is little evedience, but it would make a great degree project. Anicdotally I think they make for a more secure, safer and cleaner IV system and I would always recommend.

If you are Considering switching but not convinced, I would suggest 1 or 2 months trial then reassess?

RE: Use of T-Connectors/IV catheter protocol

apache — Mon, 19 Mar 2018 01:00:56 GMT

As nurses and vets practising evidence based medicine this is really important.

RE: Use of T-Connectors/IV catheter protocol

James Colver Cert. Ed, RVN — Mon, 19 Mar 2018 00:15:48 GMT

Perhaps there is a sparse evidence base pertaining to whether you wipe the cannula site 2, 3 or 6 times from which to reference. In lieu of this, the panel of clinical advisers and their qualifications is enough to convince me that the advice is at least pragmatic.

The justification to use swabs rather than cotton wool I suspect is to lessen the risk of contaminating the site with lint.

RE: Use of T-Connectors/IV catheter protocol

apache — Sun, 18 Mar 2018 23:22:25 GMT

The Bella Moss site is a good resource, but a shame the guidelines are very didactic and not referenced. Where do they get the 72 hour maximum duration from? If you hospitalise and cannulate at 9am on Monday do you really need to change a perfectly good cannula on Thursday at 9am when the dog is going home at 3pm? How do they justify swabs over cotton wool? How do you know you need to clean the skin exactly 3 times and not 2 or 6?

We're debating the use of T-pieces in our practice (one of the vets has used them elsewhere), but I remain relatively unconvinced of their benefits. Her like of them is the ease of disconnecting fluids when walking out dogs, but my concern is disrupting a closed system as the 'dirty' end. I feel much happier changing a bag at the clean end of the giving set. I worry about contamination from re-capping, and then new caps each time all have to be paid for. The cost to the practice is only £5 or so but that adds up and doesn't account for the extra waste (necessary waste?). It's quicker and easier taking a dog out connected to the drip. A simple injection bung fine for IV injections.

RE: Use of T-Connectors/IV catheter protocol

V E S — Sun, 18 Mar 2018 11:08:12 GMT

Thank you, I have had a good search but cannot find anything!

Lovely, what a great website, mugh appreciated!

RE: Use of T-Connectors/IV catheter protocol

James Colver Cert. Ed, RVN — Sat, 17 Mar 2018 22:41:23 GMT

Hi! Not sure about articles for t connectors etc. will have a look. For i/v cannula protocol see the resource section on the bella moss website :)