How often would an administration set be changed on a drug given prn but with a six hour stability? Would you change the administration set every six hours like the drug? Or is it ok to use for 24 hours as an intermittent administrataion? Does using a vented or nonvented administration set alter the resuslts?
Vented sets should only be used on glass bottles as they are designed to allow air to enter the container. A nonvented set should be used on a plastic bag. If you only have vented sets available, it will work on a plastic bag and there are no studies indicating a more frequent change based on this feature alone. The key to changing any administration set is not based on the stability of the fluid or med. It is what you are doing with that set. If it is remaining connected to the catheter or primary administration set, it can be changed at 96 hours. If it is being disconnected and reconnected with each dose, it must be changed at 24 hours if the male luer end is protected with a sterile dead end cap between uses. If not protected, it should be discarded immediately after it is disconnected because it will become contaminated with the end cap. 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
Hi Lynn,
There are alcohol caps on the market for the male and female ends. I had an in-services the other day on one certain brand that stated disinfection in 30seconds of application. It was hinted that if the tubing end was not previously covered with a sterile cap, application of the cap would disinfected it for use. It was also implied that intermittent IV tubings could be used for more than 24hrs. I am not sure that I by into that thought yet- need more evidence.
I am wondering if there will be any change in tubing changing times with use of the alcohol caps in the new standards when they come out. I would like to have alcohol caps at my facility. It always helps to push it through the red tape the more ways the facility may save money buy using them.
Thanks
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ
Those "hints" as your called them are not evidence based information. We do have several studies on the use of the disinfection caps on the needleless connector attached to the catheter hub. There is some limited evidence for use on PIVs also. There is absolutely no evidence that the application of a cap with alcohol to the male luer end of the intermittent IV set would render it "sterile" and certainly no evidence to using these sets for longer than 24 hours. If any of this information was spoken by a sales rep, I would promptly inform the rep to supply those claims in writing from his employer. When they can't do that, then totally dismiss what was said. Since there is no evidence about any type of medication administration set, there can be no changes. Disinfection caps are addressed in the SHEA 2014 update on CLABSI and will be in the 2016 INS standards, although the final content has not been written yet. The length of time for disinfection of any disinfection cap should be based on lab data conducted by the company. This time is 3 minutes for one brand and 5 minutes for another. So I find it hard to believe that 30 seconds would be adequate. Did you see this data from the manufacturer? If not, ignore it. It is time for all nurses to expect all claims made by all sales reps to be provided in writing from the manufacturer. Without such information, anything stated by another company rep must be ignored in favor of published evidence. 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
thanks Lynn,
Yes, it couldn't provide any evidence regarding the tubings being used longer. When he hinted it was one of those -shoulder shrugs and expressions of draw your own conclusions. No, not in todays practice, I want and need evidence to support our practice. I was wondering if you had seen anything regarding it.
He did say that they were 5 minutes for disinfection, but that they had just changed it to 30 seconds of disinfection. I can't remember if he used the words "approved for" or that they "proved". Seemed like a big jump to me.
I agree that sales reps make claims about their products. I don't accept anything without the evidence to support it. Their goal is to promote their product so that facilities will purchase it. My goal is to provide the best evidence based (and cost effective) care to my patients. Without evidence it is all just talk! I was hopeful that there was some evidence out there. Thanks for your input
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ
Lynn,
This is in response to your post on July 8, 2015 which was based on a query from Juline DiSilvestro, BSN, RN, CRNI, VA-BC of Inspira Medical Center in Woodbury, NJ.
On June 12, 2015 Catheter Connections, developer of DualCap™ disinfectant caps, announced that we had updated our Instructions For Use (IFU) and enhanced the indications for use for our DualCap™ disinfectant caps to be effective for disinfecting both the needleless access ports as well as the male luer connectors. The new indication for use is: When left in place for 30 seconds, the disinfecting caps disinfect the luer access valve and the male luer connector and provide a physical barrier to contamination for up to 7 days under normal conditions if not removed.
This is a change from our initial disinfecting times of 5 minutes and 96 hours, to 30 seconds and 7 days after supplying the FDA with the clinical data to back up the claim.
In our submission, we showed that our time kill assays (30 seconds) demonstrate a 4-log reduction against the following microorganisms:
Staphylococcus aureus
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
Streptococcus pyogenes
Enterococcus faecalis (vancomycin, gentamicin, and streptomycin resistant)
Candida albicans
Candida krusei
This change will enable greater flexibility in use for our valued customers, and continues our commitment to develop our DualCap™ product line to meet customer needs.
I would be happy to send you the updated IFU’s for the Light Blue disinfecting cap and the Dark Blue disinfecting cap if you would like.
Thanks and please feel free to respond with any questions.
Regards,
Julie G. Anderson
VP of Marketing
Catheter Connections, Inc.
Julie G. Anderson
Catheter Connections, Inc.