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mary ann ferrannini
primary intermittent tubing and multiple secondaries

    I know the INS states that primary intemittent tubing should be changed every 24 hrs. I read the old and new draft of the CDC guidelines and it does not specifically address primary intemittent. Now, my second issue is that I see a lot of nurses using multiple secondaries and connecting and reconnecting multiple times ...They are doing this b/c they are worried about incompatabilities...I say it is safer from an infection control standpoint to backflush and leave the secondary connected..this assumes of course, that all the secondaries ARE compatable with the primary IV solution. I also say that if they are connecting and discoonecting any secondary tubing that it should then get treated as intermittent tubing?.....Is everyone out there changing theri primary intermittent tubing every 24 hours or is anyone doing something different?...any and all answers would be appreciated!!! Tx in advance>>>mary  

lynncrni
You are absolutely correct!!

You are absolutely correct!! Secondary sets for piggybacking should remain connected to the primary continuous set and be changed all at one time. When they are disconnected, they become an intermittent set and should be changed at 24 hours. All studies on IV administration sets have either excluded these secondary sets or medications tubing or they have not provided any information on their use. So there is absolutely no data to base your practice on for these sets. It is for this reason that INS takes the conservative apporach to change at 24 hours. CDC states to access all needleless connections only with a sterile device. There is no possible way to convince me that intermittent sets connected and reconnected will remain sterile after 24 hours. Heck they may not be sterile after the first use. We have focused so intently on the infection risk from needleless connectors, however it does not matter how well you scrub that connector surface, if you are connected a contaminated tubing, you are still introducing bugs. This is a 2 sided system!! 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

mary ann ferrannini
Thank you Lynn..  for your

Thank you Lynn..  for your answer...now I have something I can print and can make some changes!!!! Mary

mary ann ferrannini
Thank you daylily as

Thank you daylily as well....Mary

daylily
Mary ann

We change our intermittent sets q 24 hours.  Nurses are required to label the primary, secondary, and flush bag with 24 hour stickers.  I round on all the units/rooms quarterly and provide a report of compliance showing each unit in comparison with the others.  This also includes 96 hour labels for continuous infusions.  Compliance has greatly improved.  Our infection rates have dropped (we not only calculate rates for critical care but all areas outside of critical care).

Our continued problem is that nurses will disconnect continuous tubing to run incompatibles rather than setting up a flush system and attaching to the distal end of the continuous tubing.  My thoughts are that if you are disconnecting the continuous to do this, the continous should be treated as an intermittent and changed every 24 hours.  Its hard to get compliance on this one if a patient only has one PIV.  Some will have (2) PIV to alleviate but not all patients have adequate access for this.  Multi-lumen central line is an option but I try to discourage routine disconnection.  I think the battle will be ongoing......

Vanessa M
intermittent tubing definition

Would you consider any tubing you disconnect from IVs or CVADs as intermittent or is there a limit to the amount of times it could be disconnected? Would a once a day IV antibiotic be considered intermittent?

Thanks!

V

 

lynncrni
All sets that are connected,

All sets that are connected, disconnected, and then reconnected to a primary continuous IV set or directly to the catheter hub itself is an intermittent set. So yes one used for q 24 h meds would be an intermittent set. All studies on IV sets have provided data on continuous infusion sets. There has never been a study that provided data on sets used for intermittent meds. With the most recent CDC guidelines they have now recognized that there is a difference between continuous and intermittent sets and stated that intermittent set change is an unresolved issued due to this lack of data. INS has always taken the position that intermittent sets should be changed at 24 hours because this was the original time limit for set use from the beginning and there is not data stating that it is safe to extend the use intermittently beyond 24 hours. 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

Vanessa M
Thank you Lynn!

Thanks Lynn for the clarification! This will definitely be a practice change for our RNs! I am happy to have your 'back' and INSs 'back' when I go to rock the boat! :-)

lynncrni
You are welcome! Don't fall

You are welcome! Don't fall out of that boat when you rock it but you should be rocking it as this would decrease risks to patients. 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

Randy McCown
Our hospital is also

Our hospital is also wondering what others are doing re the new guidelines for primary continuous and primary intermittent tubing.

We are piloting a couple units for the 7 day primary continuous administration set and want  to know how othere are interpreting when it becomes primary intermittent. I saw Lynn's comment re the once a day abx.  What about when it is only disconnected for a short period of time. Is there a time frame for reconnection that it could still be considered primary continuous or is it meant to be black and white......once the primary continuous set is disconnected for whatever reason it becomes intermittent.

An example for us would be, the PICC team changes a dressing and disconnectes the tubing to check patency and attach new valves. Does this primary continuous  set now become a primary intermittent intermittent?

Thanks,

Randy

 

lynncrni
I am amazed that this issue

I am amazed that this issue is so hard to understand. First, the overriding, all important goal is to minimize manipulation to the catheter hub and IV sets as this will minimize the risk of intraluminal contamination and subsequent CRBSI. I have some issues with the practices you described. First, checking lumen patency even when continous fluids are infusing does not require that the IV set be disconnected from the catheter hub. There are injection sites on IV tubing that can easily be used for this purpose. Second, there is absolutely no need to have a needleless connector in the line when fluids are infusing continously. I repeat - NO need for a needleless connector when you have continous fluids infusing. We know that needleless connectors carry a risk for bioflim growth and are a source of CRBSI. So it makes no sense to add them when continous fluids are infusing. Connect the IV set directly to the catheter hub using a luer-locking device. Leave it connected until it is time to change the set. When you have a needleless connector in the line, it facilitates bad practice by making it far too easy to discoonect the infusion frequently. This disconnection practice must be addressed in policy and procedure, when is it allowed, for what reasons, when is it not allowed, how to safely protect the set while disconnected, how to safely ensure that the set is reconnected correctly. For instance, changing clothing, ambulation, taking a shower, eating, etc are not valid reasons to interupt the fluid flow as this increases catheter and tubing manipulation and it stops the infusion of prescribed fluids and medications, meaning that the therapeutic response will be altered. So the new fluid container should be connected to new IV administration set, then the opposite end connected to the catheter hub. It should only be opened when it is time to change the entire system at 96 hours or whatever your policy states. New container, new tubing all changed at the same time. Prevent air getting into the line by proper patient positioning and use of the clamp on the catheter itself. If you are considering extending set use to 7 days, I would strong encourage you to contact the manufacturer of your sets to get their comments on this practice. Many have not been tested for use over this extended period.

Intermittent infusions are when the fluid (cyclic TPN) or medication is prescribed for intermittent infusion (30 minutes up to ~10 hours for TPN), leaving the patient not connected to any infusing fluids during the intervening period. This is when a needleless connector should be used to close the system. These sets should be changed at 24 hours due to the manipulation of both ends of that set with each use.

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

Randy McCown
Thank you very much Lynn for

Thank you very much Lynn for your response. Very helpful.

Randy

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