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