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Peter Marino
24hr line change

When IV tubing is being used for intermittent infusions. The standard is to change the tubing every 24 hours, correct?

Assuming I'm correct (I don't have the standards in front of me), if a continuous infusion is changed to an intermittent one. When should the tubing be changed? Should the 24 hours start at the first interuption (line capping) or when the tubing was first hung (sterile package opened)?

Thanks

Peter Marino RN BSN

pfintonis
Administration set changes

Administration set changes are detailed in section 48 of standards of practice for quick reference. It does not refer to this situation. In fact, I'm trying to think of a situation where this whould happen. TPN perhaps for noc supplimentation. But that is q 24h anyway. Fluids? I would consider the change in practice would change with the change in infusion. Once the continuous infusion is stopped, I would count that as hour #1. But set changes should be timed to take place with bag changes and catheter changes. Pure speculation on my part, but seems to make sense. pfintonis RN CRNI

Peter Marino
 Thanks for the

 Thanks for the comment,

Many times a Pt. will be on fluid replacement or maintance and concurrently recieving antibiotics. When the fluid is Dc'd, the anbx remains. Many (if not all) RN's will just stop the infusion and cap the line (hopefully cap the line) and continue to run their piggybacks with the same lines.

Basically making a continous infusion (72hr line change) into an intermittent one (24hr line change). IMO, once the package has been opened(or the seal broken) the clock is running on said tubings experation time (whether spiked or not). To answer my own question, I would say, that the tubing should be changed 24hrs from the time of becomming  intermittent or the end of the original 72, which ever comes first.

Hasn't the standard changed to 72hrs for TPN?

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Peter Marino
Well after checking my mail.

Well after checking my mail. I see that Lynn H. has sent a survey out on this very subject. Please let us know the results Lynn. I would be interested to hear your opinion on this thread.

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

lynncrni
Any and all sets used for

Any and all sets used for intermittent infusion should be changed at 24 hours because both ends of the set are being manipulated with each use. There are no published studies that have reported on intermittent set use and I strongly believe that its use is quite different from a continuous infusion set.

 TPN sets have not changed. Since the 2002 CDC guidelines, a tubing used for parenteral nutrition can remain in use for 72 hours. When fat emulsion is either admixed with or piggybacked into the PN set, it should be changed 24 hours. 

 When the therapy changes (continous to intermittent), the set should also be changed. A continous set should not be used as an intermittent set. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kristin Walker
I'm currently revising some

I'm currently revising some of our IV policilies and am a bit confused that the INS Standards state that on intermittent infusions, all tubing must be changed every 24 hrs, including the change of add-on devices such as extensions. I agree the tubing needs to be changed and anything that is attached to the tubing prior to connection but I think it is unnecessary to change the extention that is connected to the catheter.  I would think this would increase catheter related problems if you are opening up the device every 24 hrs.  We are currently using BD Picc's/ Midlines and the extentions are added on upon insertion.  Our current policy states that the extensions need to be changed every week with dressing changes & prn.  Does anybody have any opions on this?

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

lynncrni
I think you are
I think you are misunderstanding what the INS SOP states. Standard 48, II, Practice Criteria F states that the add-on device changes should coincide with the set changes. This does not state that all must be changed at the same interval. It only means that all should be changed at the same time. In other words, don't open the line to change an extension set and then a few hours later open it again to change another component. I would agree that this statement is a little odd when referring to intermittent sets since the set is connected and disconnected more frequently than the components attached to the catheter hub. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kristin Walker
So are you saying that is OK
So are you saying that is OK to change the extension that exists as part of the catheter on a q week & prn basis and we should define "tubing" as anything that becomes disconnected after an intermittent infusion is completed?

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

lynncrni
Yes, that is the way I have
Yes, that is the way I have defined it for 25+ years of PICC experience. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Carla Yusufi
Could someone please help me
Could someone please help me to determine what the standard is for capping off tubing during intermittent infusion? Is a sterile dead end/luer protective cap necessary? Can one use the cap that comes on the flush? What is best practice?
lynncrni
In clinical practice, I have

In clinical practice, I have always discarded the tubing attached to the primary bag and set up a new intermittent tubing when the next drug was due. So now need to worry about when the first set was hung, etc.

 I did conduct a survey on intermittent tubing use and will be getting a report out soon. Lots of other projects have got in the way but I promise I will not let this fall off my radar screen. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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