I'm wondering how many have this in their policy? Do you make allowances?Â
We are looking to incorporate this into our practice along with changing our tubing utilization. I can foresee problems. Patient's that are restarted multiple times within 24 hours (do you put a time period in that you would use the same tubing within the 1st 24 hours and then change the set after that)? If blood has backed up the line - and the IV needs to be restarted, would you change the set? Would you just swab the male end with alcohol or some other agent?
Do you have specifics written in your policy or just a blanket statement?
Blood in the set always requires changing. For a PIV, I would always use a short extension set that would remain attached to the catheter and all tubing is changed from that set upward. On those frequent restarts within 24 hours you could just change that extension set. It is very easy to contaminate the tubing when connecting it to a traditional catheter - blood coming out, very close to skin surface, moving patient, etc. So I would want to have that extension set to always change even though the entire set may not be changed. I would always prefer to have the date for the catheter insertion and tubing to be the same, just to make it simpler for the nurse on the day of change. This is the way I have always practiced, but don't think we ever had this in writing. In the case I am thinking about, the IV team did all the starts and restarts and that is not the same today. You would need something in your procedures to address this.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
We always recommend replacing with fresh IV tubing when switching over from PIV's to a brand new Central line/PICC line as to prevent cross contamination. If they don't want to replace the whole system, at the least re-spike the current bags (esp. drips and TPN). We also recommend to do the same with PIV's, but these are not hospital-wide policy, just a conscience reminder for the bedside nurse. We figure, tubings are cheaper than treating BSI's.
Roger
We are changing our policy to incorporate intermittent tubing tubing changes every 24 hours. When continuous tubing becomes interrupted it is considered a intermittent set and is good for 24 hours.
My question is what if it is interrupted because the PIV fails. This can happen frequently for various reasons. Would you hang a new IV set? I realize that eliminating a BSI would pay for this additional expense, but you need the money in the budget to pay for additional tubing usage.
Our Infection control nurse states that we could respike the infusate with new tubing. There are times that these leak if you do that and it would require the bedside nurse to use critical thinking in regards to an antibiotic that is 1/4 infused, 1/2 infused etc.
Lynn - our current policy is that every PIV have an extension. We utilize a short 7" extension on our over the needle catheters and the Saf-T-Intima which has a built in extension, so are recommending that if we change the IV we could use the same administration set, of course as long as there is no blood in the tubing?
We would like clear guidelines to take out the guesswork, but I'm finding it increasingly difficult.
Of course there is no research to address these tubing questions. But I would always change the tubing if the PIV was changed due to phlebitis because this can have an infectious cause; if the PIV was restarted on a date different from the original date of the tubing use; if you have any reason to suspect that the entire tubing has been contaminated or its integrity is compromised in anyway; and when changing from a PIV to any type of CVC regardless of the tubing dates. I would change the extension set only when the cause of a PIV restart is infiltration and the tubing was hung the same date; the cause of the restart is for other reasons such as the patient pulled it out and the tubing was the same date. Look at the other reasons for the situation of needing to change the PIV on the same date as when if was first inserted. If these are mechanical reasons and there is no question of infectious causes, I would change the extension set only. I would always change the entire tubing if the restart was done on a different date. In other words, if the tubing were 24 to 48 hours old and your policy called for 96 hour use, I would still change it with the PIV restart. I think there will have to be some critical thinking skills on the part of your staff nurses and it might be impossible to write a procedure or guideline to cover every scenario.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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