TKO IV Questions

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Timothy Condon
TKO IV Questions

I am a member of a committee looking into the use of TKO IVs. I work in the ICU and we have patients that need frequent antibiotics and we use TKO IVs frequently. Unfortunately we do so either without an order or with an order that reads “TKO IV”. In order to rectify this we are building a TKO IV order set. In order to get this order set through the various committees that are required for approval we need to back this order set with some evidence. So I have two questions I would like feedback on:

1. Reading past discussions on this site I have seen people say that there is no evidence that any specific low rate helps to maintain catheter patency, but what specific evidence is out there in regards to IV patency and TKO?

2. It seems to me that if a patient has frequent IVPBs and the tubing is connected then disconnected frequently the chance for infection increases as compared to a patient with a TKO. Does anybody know about any evidence dealing with IV infection rates and TKO IVs.

lynncrni
Infusion of any IV fluid

Infusion of any IV fluid requires a patient-specific rate to be considered a legal order. Without a rate it is not complete. There is no evidence supporting any specific rate that will keep an IV catheter or vein patent. This research does not exist.

You are correct that multiple meds with frequent hub manipulation increases the risk of CRBSI. So using a "carrier" fluid such as saline and piggybacking all intermittent meds into that line is the best method. All tubing should remain connected between each dose and all tubing should be discarded together at either 72 or 96 hours.

So you can write a policy that says TKO or KVO equals XX per hour or you can expect your physicians to write a rate for each patient. There is no evidence that I have ever found to support the first suggestion. I have never seen any studies and I have looked.  

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

mary ann ferrannini
Our policy is 20 ml per hour

Our policy is 20 ml per hour in the adult population. I can tell you that on my outpatients with any CVC ( including PICCs) we set a KVO rate of .2ml per hour and all the lines stay open.

 

lynncrni
Is that 20 mL per hour

Is that 20 mL per hour written as part of your policy and procedure? If not, then you are actually prescribing this rate, which is outside the scope of nursing practice. For the 0.2 mL per hour, this is on a pump with a constant forward motion on the fluid flow. It will not apply to all pumps, patients or situations. Some of the ambulatory pumps have data to support their keep-open rate, but that rate is very specific to that brand of pump and can not be applied to all pumps, patients, or catheters.  

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Timothy Condon
Your comments have been very

Your comments have been very useful. We are going to write the policy to say that the rate should be 15ml/hr and that a 250ml bag of saline shoudl be hung to insure that no fluid is up for more than 24 hours. It is already our policy to change tubing every 72 hours.

 

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