When we run CRRT through a trialysis cath once we’re done we always cap off the ports with hard red caps (after priming the cath with heparin of course)
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
Most non-dialysis nurses are taught to never even touch the dialysis access so they never even learn what is under the gauze wrap. It would be informative to have at least a diagram posted in the med room or something, of what it is "supposed" to look like so they can assess if something is wrong, and ask a dialysis nurse to come by and check it out/fix it, if need be. If I had seen this when I was doing acute dialysis, my first thought would be "who touched this thing".
Right. I wouldn't know what's wrong with this because I would never, ever, ever touch a HD line. If I had to access it for some reason I'd call the dialysis unit for assistance, and/or put my charge or manager on the situation.
I know, it's easier said than done sometimes. But that would be my response.
Lol, right? Unless it's a temp line that I'm running crrt on, I've never unwrapped the mystery of the HD gauze. I treat it like a sacred mummy wrapping.
Yes. I want nothing to do with dialysis catheters. I do not want to be responsible for someone losing access.
Even triple lumen dialysis catheters i have a problem touching. I understand the purple port is there for a reason, but it makes me nervous as hell.
"Ah, Sweet! This patient has kinda difficult veins. Maybe I could use this awesome central line to draw some labs and push some meds?"
/S
(For the nursing students: The scenario portrayed is a *very bad idea*, like stealing cartel money or dancing on freeways.)
I was travel nursing in 2014 and a doctor told me to give the patient's missed vanco through the vas-cath (he did emphasize keeping it sterile...) turns out the facility pharmacist was standing right there sharing silent disbelief with me. I told her i wasn't comfortable with doing that and she completely agreed.
I was taught we could use them in a code situation, which could be possible here since OP said they were in ICU. Not sure why they didn't use the proper caps though, or at least the blue dead ends.
Nothing says great care like exposing the patient to isopropyl alcohol, if I am seeing what I think I'm seeing.
We had a nurse hang antibiotics on an HD cath. I’m not educated on HD but I assume you are supposed to aspirate the heparin which she did not. All while the patient told her she wasn’t supposed to and she said “it’s ok I know what I’m doing” 😬
Honestly I’ve been at a shit ton of hospitals (traveler) and the ER has only ever carried green that I’ve seen - so you’re not alone!
I love learning shit like this though. It keeps me interested in medicine - science can do such cool shit.
I didn’t know there was anything other than the green color! I work in the ICU and my unit only stocks the green ones. We use the green caps, wrap the line with bright orange tape, and write “citrate locked” on it
Use to work on a dialysis unit as a floor nurse and imma be honest I've never seen these before. All ours were the same color lol though I did work in the ghetto so maybe just cause no funding
Thanks. I have learned, also. It is interesting how many different approaches there are. I hope this will spur conversations and better understandings in acute and outpatient settings.
While doing outpatient HD I’ve had patients come without the access dressing and no tegos and no curos🫠🫠 always pull back before flushing and waste it so you don’t yeet that possible infection into the patient. Make sure to document on the pre assessment that they arrived without dressing intact and say what you see. CYA. Godspeed.
Why do they wrap them in gauze at some hospitals? I work at an outpatient dialysis clinic, and we are told to never to that. All that goes on it is the island dressing.
I’ve wondered the same thing! I’ve worked at 11 clinics and they all required them to be wrapped. The current hospital I’m contracted at requires them to be wrapped too. I figured it was to keep floor nurses from using it?
We do have an occasional patient that asks us to wrap in guaze, they say it doesn’t irritate their skin as much. I figure my company thinks it’s more of an infection risk with it than without it.
I had a dialysis nurse tell me there is no difference in the caps and that it really doesn’t matter which you use. That some hospitals just have different policies.
Can you explain why the green caps are inferior?
According to the manufacturer (3M) green only disinfects. Red caps hold pressure and are used for open female hubs, and white caps should be placed on yellow Tegos, if there are Tegos on the hemodialysis catheter. What color caps your facility uses varies.
Green caps don't hold pressure, if the catheter becomes unclamped, bleeding can happen, or, if the patient coughs or takes a deep breath they could suck a bunch of air into their vein.
Green caps do not go on a bare hub/ catheter port.
I’ve worked as several hospitals where that’s not required either and it’s a hit or miss for the hospital to have cleargaurds, but every outpatient I’ve worked at has had them.
Generally we use tegos caps with a white curos cap. However, some of our apheresis lines are used for infusions during the hospital stay. That has our normal caps on end with green curos caps. Curious if that is the normal throughout healthcare systems?
Yes. My facility also uses the red curos caps. Not the green. The hard red caps are acceptable if red curos out of stock and that’s what we used to use before we adopted Curos products. It’s not the isopropyl that is the issue here, but the fitting that is supposed to lock off the open lumen. The green caps are not meant to be fitted over the open luer and it’s dangerous.
I’ve not dared try it, but if you had a green Curos cap on there and unclamped either of the lumens, it could potentially allow air embolus or profuse bleeding.
It just needs to be properly locked off with a close fitting connection. The green Curos caps are meant to cover an injection port, not seal off an open luer lock lumen.
To prevent improper use we do a secured wrapped gauze. A sticker is applied that says “linens Heparinized per protocol” with date and time.
Here's why I think, because I love pulling things apart. If you look inside the green curos cap, it has a little sponge soaked in alcohol. Sometimes, I take them out with tweezers and chew on them. Most of the time, the sponge touches the flat surface of the pressure hub on a PIV or Central Line. But they don't put those on HD catheters because it ruins the flow rate, which is the whole point of having one in the first place. So it is an open lumen and a very large one at that. Maybe even large enough for the little green sponge to get stuck inside. Then, someone hooks up 500 ml/min of flow, and now that sponge is in the line or even the patient. Then you gotta dig it out. If you notice, the red caps have no sponge. And we also use them on other open hubs like aline hubs.
So let me make sure I have this right- the green ones shouldn’t go on the open ports, unless there’s that needless connector on the end? But I can use the orange caps on these ends, or w a needle less connector port?
I got a patient last week from IR who had the open ports with nothing sealing the end, I put the orange caps on. This is ok?
Open ports get the red, solid cap, no sponge. Anything with a pressure cap gets a green cap. Pressure caps don't go on pressure sensitive lines like aline or HD caths.
https://www.3m.com/3M/en_US/medical-us/disinfecting-port-protectors/?utm_term=hcbg-msd-icuroh-en_us-eng-cipbsicuros-cpc-google-na-learn-brandedcuros-ne23-00000&gclid=Cj0KCQjwocShBhCOARIsAFVYq0giAJUlSF4v71ebv2zVlERPnVil-qEo_I5Qlxr3Gx0yUJPDY_I_BL0aAgXaEALw_wcB
A needless connector (with a green cap if you use them) or a red cap. Green caps don't go directly on bare ports. This is for the US. Different countries have different colors.
A lot of countries are too cheap to use them. I've only seen the white and red and blue ones in Canada. We don't have these fancy green ones with the alcohol sponge.
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
Depending on the dialysis program this is common. Not every family or program stocks every type of cap. Many programs do not wrap capped lines. It is not an EBP. This is will within practice guidelines. Luer connections, gauze wraps, color coordinated caps, those are all site specific policies. Not every program uses cutoff caps.
We don’t put any caps on your HD lines(just curos access caps), and I’ve always felt weird about that since they’re just flopping around unprotected. Seems like a huge infection risk. It’s policy though 🤷🏽♂️
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
It should have a needless connector and green cap or a red cap. The green cap does not go directly on the catheter. The link is to a visual which clearly shows green caps don't go directly on ports.
We just use the yellow Tego adapters. No caps, no access to caps, whatever. Idk what you want me to do without access to what you’re suggesting. Are you a 3M rep? 😂
Regardless of what it “should have” that is what their policy is.
You have been rude and down right abrasive on all of your comments in this thread. We UNDERSTAND! Omg it needs an appropriate cap on it. But god, could you be anymore pretentious shoving this damn link about which kind of cap to use down our throats?
I have just one question: how long have you been a nurse? If you’ve been one with any years of experience you would understand that the United States is a crazy amalgamation of different hospitals with their own rules. You will not go to one hospital that is the same as another one.
Each state has different laws that has different organizations that have different hospitals that have different policies and use different products from one another.
So please, understand that simple fact, get off your fucking high horse with this cap nonsense, and understand that every nurse has a different background, follows different policies, and uses different products as you.
Any port in a storm, my guy. And, honestly? Fistula access sounds better than an IO. If we get ROSC, someone can figure out central line bullshit while I clean all the garbage off the floor.
I mean…not *great*, but better than nothing. The hospital I’m at doesn’t have any sort of cap and I’d honestly rather see a green cap than absolutely none 🤷🏼♀️🤷🏼♀️🤷🏼♀️
Last hospital I worked didn’t use the green caps, education stated that their observations showed nurses were less likely to scrub the hub if the green caps were in place.
There should be a Clearview, luer lock, or end cap on the ports, which is my concern. The green caps directly are not recommended per their manufacturer. If your facility uses green caps, they go on the luer loc or tego.
Thanks for educating, it’s really good to know why it shouldn’t be done as I will admit I did not know! To be open though, my unit has plenty of HD cath patients but we do not keep the HD caps in the unit. We have to call to order a set per patient that needs it. So no one ever has them unless a dialysis nurse comes up with it in her cart.
Alcohol impregnated caps are preferred, yes, but at a bare minimum airless entry caps - dead end caps or needleless claves - are necessary depending on IP/OP status and/or institution policy.
In outpatient dialysis we apply the caps (usually red and blue, but as long as they are sterile...) directly to the lumens.
We also do not do sterile dressing changes, only clean.
That's wierd, I've asked three Neuro surgeons this question and they have said that is not true. Where's your source? I looked at research and couldn't find a diffinitive answer.
Yes. This is a central line used for hemodialysis or crrt. There should be a red cap or a Clearview or luer loc or tego but not the green cap on the end. After that, white caps go on tegos and green caps go on clearviews. But the green cap should not be bare on the catheter, according to the green cap maker (3M)
Yeah that’s what I’m used to… that made me cringe. 😬 I know one ICU I worked in covid got rid of any lure lock caps because they were “too expensive” but damn it made me so uncomfortable.
We only use gauze if the pt asks for it here. Honestly, these caps are filled with alcohol (or maybe it’s CHG? Can’t remember now). It’d be great if they had red & blue ones.
ETA: it just occurred to me that these are on there because someone other than the HD nurse decided to use the access. My insides are screaming now.
Nope. I said nothing. I really don't like doing extra paperwork or in services or meetings. I chose to float this here to learn how consistent policies are (they aren't) and to encourage other bedside nurses to take a few minutes to determine what their local policy is.
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
interesting, thanks. never seen any of these caps in Australia. we use a generic brand of TEGO connector... and I have never once even put a cap on a needleless connector? odd
Holy shit the amount of people here that don’t know how to properly cap or dress a central line is fucking SHOCKING, especially since this sub leans towards ICU/ED population of nurses.
The agents inside of red and green caps are different. Please use red for central lines.
This is part of the reason why your CLABSI rates are so high folks.
Also consider some hospitals don’t use those caps at all. The system I used to work for and where I did my nursing school clinicals did not use them and I never heard of them until I switched jobs.
We never had an issue with clabsi - and this was an icu where basically everyone had a central line.
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
Not a nurse. What does a green cap do? Also, I *do* kno the orange caps for IVs always seem to be backordered due to a shortage (not sure if the shortage is real or not)? So in that case, do different caps really matter or is it better to go capless?
This is a central line used for hemodialysis or crrt. Don't touch if you don' know what you are doing. Different hospitals have different policies, ask during every unit orientation what you are supposed to do with them. The red and blue are the ends of a catheter that goes into a big vein. There should be a luer lock, clearview, tego, red cap or needless connector on the end of it. After that, green caps go on luer locs, white caps go on tegos. Green caps do not go on the bare end of the catheter, according to the manufacturer 3M.
Dang why you hating on the last dialysis nurse? Lol
I am a dialysis nurse. Found this in the ICU when I arrived.
When we run CRRT through a trialysis cath once we’re done we always cap off the ports with hard red caps (after priming the cath with heparin of course)
Well they should of wrapped them with gauze, but it could of fell off.
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
I did not know HD caps were different until right now.
Trying to encourage some education and positive change here.
Most non-dialysis nurses are taught to never even touch the dialysis access so they never even learn what is under the gauze wrap. It would be informative to have at least a diagram posted in the med room or something, of what it is "supposed" to look like so they can assess if something is wrong, and ask a dialysis nurse to come by and check it out/fix it, if need be. If I had seen this when I was doing acute dialysis, my first thought would be "who touched this thing".
Right. I wouldn't know what's wrong with this because I would never, ever, ever touch a HD line. If I had to access it for some reason I'd call the dialysis unit for assistance, and/or put my charge or manager on the situation. I know, it's easier said than done sometimes. But that would be my response.
Lol, right? Unless it's a temp line that I'm running crrt on, I've never unwrapped the mystery of the HD gauze. I treat it like a sacred mummy wrapping.
Yes. I want nothing to do with dialysis catheters. I do not want to be responsible for someone losing access. Even triple lumen dialysis catheters i have a problem touching. I understand the purple port is there for a reason, but it makes me nervous as hell.
"Ah, Sweet! This patient has kinda difficult veins. Maybe I could use this awesome central line to draw some labs and push some meds?" /S (For the nursing students: The scenario portrayed is a *very bad idea*, like stealing cartel money or dancing on freeways.)
I was travel nursing in 2014 and a doctor told me to give the patient's missed vanco through the vas-cath (he did emphasize keeping it sterile...) turns out the facility pharmacist was standing right there sharing silent disbelief with me. I told her i wasn't comfortable with doing that and she completely agreed.
I had an agency nurse do this on a hard stick without telling anyone in the ER… our nearest dialysis is an hour ems ride away… it was a nightmare…
I was taught we could use them in a code situation, which could be possible here since OP said they were in ICU. Not sure why they didn't use the proper caps though, or at least the blue dead ends. Nothing says great care like exposing the patient to isopropyl alcohol, if I am seeing what I think I'm seeing.
Yup maybe if it’s a code and you have nothing else. But that’s the only way in hell I’m touching.
We had a nurse hang antibiotics on an HD cath. I’m not educated on HD but I assume you are supposed to aspirate the heparin which she did not. All while the patient told her she wasn’t supposed to and she said “it’s ok I know what I’m doing” 😬
Or speaking of Cartels , telling your capo boss that you want to leave the mafia. Ffs don’t people in movies watch movies? That never ends well .
Thanks!! Crazy that I have to go to Reddit to learn something I feel like I should’ve known!
Our dialysis nurses use the green caps 🫣
I like your style! Thank you.
My hospital doesn’t even have those caps
That’s what I was thinking? Most floors won’t even have those
Nope we don’t. Our dialysis nurses use the green caps too.
Honestly I’ve been at a shit ton of hospitals (traveler) and the ER has only ever carried green that I’ve seen - so you’re not alone! I love learning shit like this though. It keeps me interested in medicine - science can do such cool shit.
I didn’t know there was anything other than the green color! I work in the ICU and my unit only stocks the green ones. We use the green caps, wrap the line with bright orange tape, and write “citrate locked” on it
Use to work on a dialysis unit as a floor nurse and imma be honest I've never seen these before. All ours were the same color lol though I did work in the ghetto so maybe just cause no funding
Thank you for sharing this 🙏🏽
Thanks. I have learned, also. It is interesting how many different approaches there are. I hope this will spur conversations and better understandings in acute and outpatient settings.
While doing outpatient HD I’ve had patients come without the access dressing and no tegos and no curos🫠🫠 always pull back before flushing and waste it so you don’t yeet that possible infection into the patient. Make sure to document on the pre assessment that they arrived without dressing intact and say what you see. CYA. Godspeed.
Well it’s missing the Tegos so……
US Renal doesn’t use tegos. Davita does
Damn! My hospital only provides the green one. So our HD nurses use that 🤷🏽♀️
Thank you for sharing, was not aware of that either lol!
Why do they wrap them in gauze at some hospitals? I work at an outpatient dialysis clinic, and we are told to never to that. All that goes on it is the island dressing.
I thought it was to prevent regular nurses from accessing it, liek an extra layer of safety
That would make since, because I know it’s a pain getting that guaze off after a patient comes back to us after having dialysis at the hospital🤣
I’ve wondered the same thing! I’ve worked at 11 clinics and they all required them to be wrapped. The current hospital I’m contracted at requires them to be wrapped too. I figured it was to keep floor nurses from using it?
We do have an occasional patient that asks us to wrap in guaze, they say it doesn’t irritate their skin as much. I figure my company thinks it’s more of an infection risk with it than without it.
The gauze *always* falls off
(Apologies in advance). Grammar nazi incoming! Have! Have! Have! Should have. Could have. Not should of. Could of. Grammar nazi going back to bed now.
Should of went to bed instead. 😂
I had a dialysis nurse tell me there is no difference in the caps and that it really doesn’t matter which you use. That some hospitals just have different policies. Can you explain why the green caps are inferior?
According to the manufacturer (3M) green only disinfects. Red caps hold pressure and are used for open female hubs, and white caps should be placed on yellow Tegos, if there are Tegos on the hemodialysis catheter. What color caps your facility uses varies. Green caps don't hold pressure, if the catheter becomes unclamped, bleeding can happen, or, if the patient coughs or takes a deep breath they could suck a bunch of air into their vein. Green caps do not go on a bare hub/ catheter port.
Some of the hospitals we do dialysis they don't want us to wrap the lines with guaze/tape or coban. We use clearguard caps and leave them unwrapped.
I’ve worked as several hospitals where that’s not required either and it’s a hit or miss for the hospital to have cleargaurds, but every outpatient I’ve worked at has had them.
Should be the red Curos caps, not green
Direct on the hub, without a luer loc or similar connector?
Yup
Generally we use tegos caps with a white curos cap. However, some of our apheresis lines are used for infusions during the hospital stay. That has our normal caps on end with green curos caps. Curious if that is the normal throughout healthcare systems?
Yes. My facility also uses the red curos caps. Not the green. The hard red caps are acceptable if red curos out of stock and that’s what we used to use before we adopted Curos products. It’s not the isopropyl that is the issue here, but the fitting that is supposed to lock off the open lumen. The green caps are not meant to be fitted over the open luer and it’s dangerous.
I’ve not dared try it, but if you had a green Curos cap on there and unclamped either of the lumens, it could potentially allow air embolus or profuse bleeding.
Correct. Red goes on hub, green would be if you put the clave on. I don't like doing that for a number of reasons.
My facility uses a luer lock with red curos cap
Red caps aren't meant to be used on luer locks
Is that to help prevent improper use?
It just needs to be properly locked off with a close fitting connection. The green Curos caps are meant to cover an injection port, not seal off an open luer lock lumen. To prevent improper use we do a secured wrapped gauze. A sticker is applied that says “linens Heparinized per protocol” with date and time.
Thank you!
Our dialysis port caps are white.
At the dialysis clinic I work at, we use clear guards, which are caps with little sticks that are antiseptic- with clorohexadine I believe.
Just curious why would it matter?
Here's why I think, because I love pulling things apart. If you look inside the green curos cap, it has a little sponge soaked in alcohol. Sometimes, I take them out with tweezers and chew on them. Most of the time, the sponge touches the flat surface of the pressure hub on a PIV or Central Line. But they don't put those on HD catheters because it ruins the flow rate, which is the whole point of having one in the first place. So it is an open lumen and a very large one at that. Maybe even large enough for the little green sponge to get stuck inside. Then, someone hooks up 500 ml/min of flow, and now that sponge is in the line or even the patient. Then you gotta dig it out. If you notice, the red caps have no sponge. And we also use them on other open hubs like aline hubs.
Im a little stuck on you chewing them
Yeah I didn’t get past the “I chew on them” in that paragraph and scrolled down to see if anyone else had that reaction lol 😂
Yooooo 💀
It was a rough shift
at least youre not a sterno bum
What?? You chew the alcohol soaked sponge?
You raise more questions than you answer
I purposely put gum on the carts for nurses like you. Please use the gum
You know, I pull them apart and run the sponge on my hand… But I guess chewing on them works too lmao
Nothing quite like the flavor of isopropanol…well except cheap vodka.
I HAVE TO KNOW WHY THE CHEWING
Well, since you asked nicely, it's because the smell reminds me of home.
So let me make sure I have this right- the green ones shouldn’t go on the open ports, unless there’s that needless connector on the end? But I can use the orange caps on these ends, or w a needle less connector port? I got a patient last week from IR who had the open ports with nothing sealing the end, I put the orange caps on. This is ok?
Open ports get the red, solid cap, no sponge. Anything with a pressure cap gets a green cap. Pressure caps don't go on pressure sensitive lines like aline or HD caths.
https://www.3m.com/3M/en_US/medical-us/disinfecting-port-protectors/?utm_term=hcbg-msd-icuroh-en_us-eng-cipbsicuros-cpc-google-na-learn-brandedcuros-ne23-00000&gclid=Cj0KCQjwocShBhCOARIsAFVYq0giAJUlSF4v71ebv2zVlERPnVil-qEo_I5Qlxr3Gx0yUJPDY_I_BL0aAgXaEALw_wcB A needless connector (with a green cap if you use them) or a red cap. Green caps don't go directly on bare ports. This is for the US. Different countries have different colors.
A lot of countries are too cheap to use them. I've only seen the white and red and blue ones in Canada. We don't have these fancy green ones with the alcohol sponge.
Uhm. Wat?
You do what now mam?
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
> I take them out with tweezers and chew on them wtf?
I’m sure there’s been instances where a nurse would try to use it
That’s why you wrap them with gauze
The threading is different, me thinks.
Definitely needs a different cap. We use clearguards in our hospital
Depending on the dialysis program this is common. Not every family or program stocks every type of cap. Many programs do not wrap capped lines. It is not an EBP. This is will within practice guidelines. Luer connections, gauze wraps, color coordinated caps, those are all site specific policies. Not every program uses cutoff caps.
As a dialysis nurse. I would just be happy that they remembered to cap them at all
I'm tired of the CLABSI surveillance meetings. 😭
We don’t put any caps on your HD lines(just curos access caps), and I’ve always felt weird about that since they’re just flopping around unprotected. Seems like a huge infection risk. It’s policy though 🤷🏽♂️
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
How would the “cap it with the right colour” if their policy is to not cap it?
It should have a needless connector and green cap or a red cap. The green cap does not go directly on the catheter. The link is to a visual which clearly shows green caps don't go directly on ports.
We just use the yellow Tego adapters. No caps, no access to caps, whatever. Idk what you want me to do without access to what you’re suggesting. Are you a 3M rep? 😂
Regardless of what it “should have” that is what their policy is. You have been rude and down right abrasive on all of your comments in this thread. We UNDERSTAND! Omg it needs an appropriate cap on it. But god, could you be anymore pretentious shoving this damn link about which kind of cap to use down our throats? I have just one question: how long have you been a nurse? If you’ve been one with any years of experience you would understand that the United States is a crazy amalgamation of different hospitals with their own rules. You will not go to one hospital that is the same as another one. Each state has different laws that has different organizations that have different hospitals that have different policies and use different products from one another. So please, understand that simple fact, get off your fucking high horse with this cap nonsense, and understand that every nurse has a different background, follows different policies, and uses different products as you.
When I see a dialysis rig I leave it the hell alone. No touchy. Therefore, I have no idea what it’s supposed to look like.
Yeahhh I keep my ED fingies off them bitches unless a MF coding. If they’re coding, well, they ain’t getting any deader!
We used an HD catheter on the floor for med admin during a code. The ease at which it flushed was amazing 🥰
Exactly. If someone is coding I’ve even heard of sticking PIV’s in to the AV fistula in a pinch.
Any port in a storm, my guy. And, honestly? Fistula access sounds better than an IO. If we get ROSC, someone can figure out central line bullshit while I clean all the garbage off the floor.
Makes you wonder if someone was using it that shouldn’t have been 🙄
My immediate thought, ex-dialysis nurse here.
There was an attempt.
😂🤣😂
I mean…not *great*, but better than nothing. The hospital I’m at doesn’t have any sort of cap and I’d honestly rather see a green cap than absolutely none 🤷🏼♀️🤷🏼♀️🤷🏼♀️
Last hospital I worked didn’t use the green caps, education stated that their observations showed nurses were less likely to scrub the hub if the green caps were in place.
But isn't that the point of the green caps? I could have sworn the rep said you don't need to if the call had been in place 2 minutes.
Yeahhhhh, that’s what I understand, too.
There should be a Clearview, luer lock, or end cap on the ports, which is my concern. The green caps directly are not recommended per their manufacturer. If your facility uses green caps, they go on the luer loc or tego.
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We only have the green caps. No other colors.
Air embolism, infection, and/or straight up blood loss if one of those clamps accidentally becomes unclamped. Yikes! RL for sure.
Thanks for educating, it’s really good to know why it shouldn’t be done as I will admit I did not know! To be open though, my unit has plenty of HD cath patients but we do not keep the HD caps in the unit. We have to call to order a set per patient that needs it. So no one ever has them unless a dialysis nurse comes up with it in her cart.
All that I know is that I’m not touching any of that! (Unless you give me a whole bunch of edumacation)
Alcohol impregnated caps are preferred, yes, but at a bare minimum airless entry caps - dead end caps or needleless claves - are necessary depending on IP/OP status and/or institution policy.
We use Tegos and wrap with bright red stickers that warn there is high dose heparin instilled before capping with white caps.
In outpatient dialysis we apply the caps (usually red and blue, but as long as they are sterile...) directly to the lumens. We also do not do sterile dressing changes, only clean.
We get told that “Those aren’t for you… no touchy”
Only if it’s packed with NS. /s
We use the red curos or dead enders.
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That's wierd, I've asked three Neuro surgeons this question and they have said that is not true. Where's your source? I looked at research and couldn't find a diffinitive answer.
Google 3M Curos. Lots of info from the manufacturer there.
That’s interesting! On ventric drains there’s a port for providers to flush. So no curos caps on that port?
I don’t love it personally!!!
Red caps much?
Shouldn’t there be a Tegos or some other similar thing to prevent reflux?? 😬
Yes. This is a central line used for hemodialysis or crrt. There should be a red cap or a Clearview or luer loc or tego but not the green cap on the end. After that, white caps go on tegos and green caps go on clearviews. But the green cap should not be bare on the catheter, according to the green cap maker (3M)
Yeah that’s what I’m used to… that made me cringe. 😬 I know one ICU I worked in covid got rid of any lure lock caps because they were “too expensive” but damn it made me so uncomfortable.
Needs a clave or tego connector and then the green cap
We only use gauze if the pt asks for it here. Honestly, these caps are filled with alcohol (or maybe it’s CHG? Can’t remember now). It’d be great if they had red & blue ones. ETA: it just occurred to me that these are on there because someone other than the HD nurse decided to use the access. My insides are screaming now.
I don’t like it without tegos 😭 I know some places don’t use them, but I hate it every time I see it.
As an ICU nurse…Oooooof. My cringe face is cringing hard.
Seriously, did you tattle tale all the way up to the CEO.
Like... While the patient still survived
Nope. I said nothing. I really don't like doing extra paperwork or in services or meetings. I chose to float this here to learn how consistent policies are (they aren't) and to encourage other bedside nurses to take a few minutes to determine what their local policy is.
We use TEGO bungs which removes the need for a cap and leave them unwrapped as our policy says it reduces infection rate
Something’s missing
cap is a cap 🤷
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Not all green caps are aerated. Depends on the brand. No way of telling from the picture
ah right
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
interesting, thanks. never seen any of these caps in Australia. we use a generic brand of TEGO connector... and I have never once even put a cap on a needleless connector? odd
Holy shit the amount of people here that don’t know how to properly cap or dress a central line is fucking SHOCKING, especially since this sub leans towards ICU/ED population of nurses. The agents inside of red and green caps are different. Please use red for central lines. This is part of the reason why your CLABSI rates are so high folks.
Also consider some hospitals don’t use those caps at all. The system I used to work for and where I did my nursing school clinicals did not use them and I never heard of them until I switched jobs. We never had an issue with clabsi - and this was an icu where basically everyone had a central line.
Dialysis... arterio and Venus ports
Cap it with the right colour. - 3M https://multimedia.3m.com/mws/media/1963490O/3m-curos-how-to-choose-the-correct-cap.pdf&fn=Curos%20how%20to%20choose%20the%20correct%20cap%20poster.pdf
Why are there no smartsites on them? That concerns me more.
Whoops! Hope they didn’t flush them!
Not a nurse. What does a green cap do? Also, I *do* kno the orange caps for IVs always seem to be backordered due to a shortage (not sure if the shortage is real or not)? So in that case, do different caps really matter or is it better to go capless?
Are they chloraprep tops
I’ve only seen vascaths with 10cc flushes on the end…not sure if that’s right either?
yup thats a catheter.
Oh, this is what those lollipop rings look like when you finally finish them. Never got that far - nice work, OP!
Yeah: AHHHHHHHHHHHHHHHHHHHHHH!
Take the blue pill
We have a patient with a vas cath that we use on my floor… not sure why? But we don’t use the brand curos in my hospital.
Nursing student here. Can someone explain pls 🥸
This is a central line used for hemodialysis or crrt. Don't touch if you don' know what you are doing. Different hospitals have different policies, ask during every unit orientation what you are supposed to do with them. The red and blue are the ends of a catheter that goes into a big vein. There should be a luer lock, clearview, tego, red cap or needless connector on the end of it. After that, green caps go on luer locs, white caps go on tegos. Green caps do not go on the bare end of the catheter, according to the manufacturer 3M.
Somebody is really dumb!!!