Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-7174

Title:

AN ACT ALLOWING CERTAIN HOSPITAL PERSONNEL TO ADMINISTER A SALINE FLUSH TO AN INTRAVENOUS LINE.

Vote Date:

3/27/2017

Vote Action:

Joint Favorable Substitute

PH Date:

3/13/2017

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

This bill allows unlicensed hospital personnel to flush a peripheral IV with prepackaged normal saline. The unlicensed personnel must be responsible for drawing blood and trained under a hospital-approved protocol that (1) indicates the level of training and supervision needed to perform this task and (2) includes education about aseptic technique and infection control. The hospital must document and maintain the protocol for at least two years after it is implemented.

Under the bill, flushing peripheral IVs with prepackaged normal saline is not considered medication administration.

RESPONSE FROM ADMINISTRATION/AGENCY:

None

NATURE AND SOURCES OF SUPPORT:

Karen M. Buckley, Vice President of Advocacy, Connecticut Hospital Association:

The Connecticut Hospital Association (CHA) supports HB 7174, a proposal permitting those drawing blood, with appropriate training, to flush the line with pre-filled saline.

CHA requests minor language changes that address technical issues and concerns raised by the Connecticut Nurses Association. They are the following:

(1) "Normal saline" means a nine-tenths of one per cent sodium chloride solution that does not contain additives and is suitable for administration to a hospital patient;

(2) "Prepackaged" means prepared by a pharmacy or a manufacturer in a sterile environment;

(3) "Peripheral IV" means a peripherally inserted intravenous line.

(b) The flushing of a peripheral IV with prepackaged normal saline may be performed at a hospital by unlicensed hospital personnel responsible for drawing blood and trained under a protocol approved by the hospital.

The hospital-approved protocol shall indicate the level of supervision and training required for unlicensed hospital personnel who perform flushing of a [prepackaged] peripheral IV. Such training shall include education about aseptic technique and infection control. The hospital shall document and maintain such protocol at the hospital for not less than two years from the date of implementation of such protocol. The flushing of a peripheral IV with prepackaged normal saline shall not be considered the administration of medication.

Patrick Charmel, President and CEO, Griffin Hospital:

Mr. Charmel, on behalf of Griffin Hospital, submitted testimony in support of HB 7174. Griffin Hospital was one of the first hospitals in the country to participate in clinical trials for a new needleless blood drawing device called PIVO, which was recently approved by the Food and Drug Administration (FDA) and released for sale. This device helps patients by reducing the number of needlesticks they endure to draw blood during their inpatient stay from dozens to, in most cases, just one. Using this device would also eliminate the risk of an accidental needlestick and the associated risk of blood borne pathogen transmission/infection for caregivers.

This technology eliminates unnecessary pain and anxiety for patients and its use should be extended to all who need it, but current regulation requires that only nurses can use the device. Since the PIVO device connects to a patient's I.V. catheter, which must be “flushed” before and after by injecting a small amount of normal saline using a prefilled syringe, only Registered Nurses and licensed independent professionals such as Physicians, Physician Assistants and Advance Practice Nurses can administer the flush because normal saline is considered medication administration in Connecticut.

Because the FDA has determined that a saline flush is not an example of medication administration, the Connecticut Hospital Association, working with the Department of Public Health and Griffin Hospital, supports HB 7174's intent to allow trained non-nursing personnel to flush an I.V. catheter with normal saline.

Edward Valente, RN, Critical Care Nurse Manager, Griffin Hospital:

As a nurse manager who is responsible for the care and safety of patients, Mr. Valente submitted testimony in strong support of HB 7174 allowing Phlebotomists and Multi-Skilled Techs to administer saline before and after drawing blood using the PIVO device, a needleless blood draw technology that can limit the number of needlesticks a patient requires to one.

HB 7174 is necessary because under current state regulations, only nurses can draw blood and flush saline using the PIVO device. This is problematic because depending on which floor a patient is located, blood drawing may only be possible through Phlebotomists and Multi-Skilled Technicians using traditional methods involving more needlesticks because they are not licensed to administer saline flushes. Passing this bill will improve the patient care experience as well as increase patient and hospital staff safety.

Ashley D'Agostino, RN, Critical Care Staff Nurse, Griffin Hospital:

Ms. D'Agostino supports the bill as a means to spread the implementation of the PIVO device, which will dramatically improve patient care. By enabling trained Phlebotomists and Multi-Skilled Technicians to flush saline, the PIVO device can be put into use throughout hospitals, not only improving the overall patient care experience but also reducing the potential for accidental needlsticks to healthcare workers.

NATURE AND SOURCES OF OPPOSITION:

Mary Jane Williams, Chair, Government Relations Committee, Connecticut Nurses Association:

The Connecticut Nurses Association opposes the bill stating that allowing unlicensed hospital personnel to perform saline flushes raises protocol questions over who will exactly do these procedures, what their training background is and how cleanliness will be maintained to prevent harm to patients.

Dr. Lynn Rapsilber, Chair, Connecticut Coalition of Advanced Practice Nurses:

The Connecticut Coalition of Advanced Practice Nurses opposes the bill stating that the flushing of an intravenous line with saline should be done by a licensed professional who has the education and training to perform such a procedure.

John Brady, Executive Vice President, AFT Connecticut:

AFT Connecticut opposes the bill stating that loosening the regulations on an invasive procedure such as administering a saline flush to an intravenous line so that “unlicensed hospital personnel” can perform it compromises patient safety.

Reported by: Andres J. Feijoo

Date: 4/6/2017