Many different types of end caps or adapters are available for home TPN consumers to use on the hub (open) end of their central venous access device.  There are needleless, dead end, injection ports, and split septum system caps.  All connectors and caps need to be changed on a routine basis.  The CDC and INS standards recommend cap change at least once weekly.  In some cases, a more frequent change may be indicated.

Before removing, it is important to clean the area where the cap is screwed onto the catheter. Use an antiseptic such as alcohol or chlorhexidine + alcohol in a swab or pad form.   Both of these antiseptics are highly effective against bacteria and fungi that may be harboring at the connection.  Apply the antiseptic with friction using a twisting motion for at least 15 seconds and allow to completely dry.  Cleaning the connection before removing and unscrewing the end cap helps to prevent bacteria from spreading into the open catheter lumen.

Next remove the old end cap. Use a new swab/pad to clean the hub. Use friction and a twisting motion for at least 15 seconds and allow completely dry.  Apply the new, sterile end cap.

Remember, when accessing the end cap or hub for infusions, flushing, or medication administration, swab the entire area with friction and a twisting motion for at least 15 seconds and allow to completely dry. Use a new swab for each access.  For example, if you flush, give a medication, flush again you have used at least 3 antiseptic swabs/pads! 
   

Excellent hub/end adapter care is a vital, yet easy step a home TPN consumer can take to  prevent catheter related blood stream infection.