Quality Assurance and Performance Improvement
Background : The disconnect-reconnect technique (DRT) and push-pull technique (PPT) are commonly used to deliver fluid boluses to pediatric patients with septic and hypovolemic shock. Maintaining aseptic technique can be challenging as both methods include many steps during which syringes and tubing can become contaminated. However, there is a paucity of research regarding the contamination risks or CLABSI (central line associated blood stream infections) rate secondary to PPT or DRT methods. This study examines the rate of aseptic violations in a simulated environment.
Methods : Ten pediatric critical care nurses were asked to deliver 500mL of saline to a simulated 25kg patient through a 22G (gauge) catheter using PPT and DRT techniques. Nurses were instructed to follow aseptic technique and administer the fluid boluses rapidly. Aseptic violations were recorded by an independent observer.
Results : An average of 32.9 (SD+/-20.9) and 17.7 (SD+/-8.4) aseptic violations per each 500mL bolus were observed using DRT and PPT, respectively. With PPT, 97% of violations occurred due to hand contact with the sterile portion of the plunger. With DRT, hand contact with both the plunger (60%) and the syringe tip (14%) were observed. With all nurses, the needleless hub was cleaned only prior to the initial syringe connection, not in between subsequent connections.
Conclusions : The simulation had a high rate of contamination events when using both DRT and PPT. Previous research suggests that repeated contact of the syringe plunger increases the risk of potential pathogens infused into the patient. Reducing the number of patient connections and reducing aseptic plunger violations may decrease the risks of hospital acquired infections associated with fluid resuscitation. Greater awareness of these risks, and the use of a rapid infusion device which eliminates these two risks, should be considered.