Our home health agency has asked us what the routine for IV tubing changes should be.
Currently they are changing:
Our policies have been 48 hour tubing changes for interrupted systems (piggy backs, intermittent hydration, antibiotics, etc.), every 120 hours for uninterrupted infusions (infusions that do not require a bag change or any manipulation of the line) and every 24 hours for TPN. These time frames were established because of the way our drugs are compounded for home infusion and the risk of infection in the home setting. What are your thoughts?
Thanks for your help,
Julie Mijatovich, CRNI, Operationa Lead VAS
Parkview Hospital
Fort Wayne, In
The CDC guidelines and the INS standards of practice both state that they apply to all settings. So that would mean:
1. continuous infusion tubing - no more frequently than 72 hours. This includes all parenteral nutrition solutions when fat emulsion is not being given.
2. fat emulsion tubing - every 24 hours
3. CDC does not make a difference between primary continous sets and primary intermittent sets or those that are disconnected and reconnected. So there is no recommendation from them on this issue. INS says 24 hours for these sets.
4. INS does state that the fluid container can remain in place for extended periods beyond 24 hours when there is a closed system and no interruption in the system. This would be your ambulatory pump sets without injection sites and a permanent attachment to the fluid container.
I am most familiar with clinical practice that follows these guidelines. No sure where you got the 48 hours for intermittent sets. 120 hours is 5 days and this would fit the "no more frequently than 72 hours". The issue of changing PN tubing has always been confusing, but CDC says it can hang longer than 24 hours unless there is fat emulsion involved. 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