Forum topic

Good morning Lynn:

Our TPN team is working on updating policies and nursing clinical skills involving Parenteral Nutrition administration. We need guidance in what is the most current recommendation related to frequency of tubing and filter changes for a lipid solution infusing separatly from the Parenteral nutrition 2 in 1 solution (Dextrose/Amino Acid).  We reviewed the main organization's statements in regards to this topic: 

1. In the CDC guidelines from 2011 we found an statement under "Replacement of Administration Sets" # 3: "Replace tubing used to administer blood, blood products or fat emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately within 24 hours of initiating the infusion (181-185) Category IB"

2. In the journal of infusion nursing Nov 2016 we find an statement: " IV administration set changes are also required on a regular basis to reduce the risk of infection.14 The tubing used to administer fat emulsions—those combined with amino acids and glucose in a 3-in-1 admixture or infused separately—must be replaced within 24 hours of initiating the infusion.14.  This reference cites the CDC statement above.  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102272/

3. The Infusion Therapy Standard of Practice 2016 S 85 under Parenteral Nutrition # B. "Replace administration sets used for intravenous fat emulsions (IVFEs) infused separately every 12 hours. Change the administrateion set with each new container; the characteristics of IVFE ( iso-osmotic, near neutral-alkaline APH, and containing glycerol) are conductive to the growth of microorganisms.11 (V). 

4. ASPEN stament  included in the ASPEN Parenteral Nutrition Safety Consensus Recommendations 2014 regarding tubing changes for IVFE uses the word "Shall" that indicates that the recommendation is to be followed strictly, according to ASPEN categories. In this document Aspen states in page 327 under Recommendations that "administration tubing and filter shall be changed with each new PN container (every 24 hours for TNAs and dextrose/amino acid formulations; 12 hours for IVFE infused separately"

Our team believes, based on information included by INS and ASPEN that tubing and fileter for IVFE infusing separately should be changed every 12 hours to prevent infection.  However,  we have are trying to play Devil's advocate and think how the hospital will think about having to change tubing and filter every 12 hours, we are thinking about cost and nursing time. Any difference in bacterial or fungal growth in lipid solution in the bag versus tubing /filter constantly infusing?  Lynn, Looking forward for your advice.