We have recently been having discussions regarding solutions and administration set change intervals. Current practice is intermittent infusions get tubing changes every 24 hours. Continuous infusion sets get changed every 96 hours. don't even get me started on solutions at this point. A question came out of the group that I am asking your input on. In the current environment we use Curos caps and Curos tips for all connections and administration set ends when disconnected. This was brought to the table 2 years ago. In light of that we wonder if administration sets could hang longer than 24hoursknowing compliance with the newer products is good? Would really like to hear as many people's opinions as possible on this question. thanks!
The huge issue is that primary intermittent sets, nor any set used to administer medication, has ever been studied in any way. All studies on IV administration sets have looked only at continuous sets allowed to remain connected until they were time to be changed. Those studies have been responsible for pushing their use out to 96 hours and there is one study out to 7 days. All of these studies have either been silent of medication sets or specifically stated they were not examined. So no studies on intermittent set use, at all. Definitely no studies on intermittent set use with these caps combined with any level of compliance - no data at all. The national standard (CDC, INS, etc) is to only access all VADs with a sterile device. I wonder if we can truly say that the male luer end of an intermittent set used once remains a sterile device, with our without use of caps. Of course, without caps on the male luer end would definitely be highly contaminated. While we protect needleless connectors with the disinfection caps, and we manually scrub them, this still will not render the connection surface to be sterile. So it would appear to me that one use of these sets would cause contamination of the male luer end. Given the high cost of CLABSI, I don't think I would want to risk extending the use of these sets when there is no data to support this change. The 24 hours came from the original guidelines set for use of all sets and goes back to the 1970's. There is no question that this is a huge hole in our research. 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
I have a question regarding the use of IV extension tubings in home care. Extension sets are routinely applied so that a patient may be able to self administer home infusion via their PICC line. I have always connected the leur locked primed extension directly to the PICC line so that there is only one infusion cap in use. The infusion cap is then changed weekly or whenever blood was drawn through the PICC. The question is the need for changing the extension tubing itself. I have read (?), but cannot locate source, that if the extension is placed at the time of PICC insert, it should be considered an extension of the PICC and that it only needed to be changed if it was damaged or not functional for some reason. The infusion cap would continue to be changed weekly or whenever blood is drawn through the cap. I would appreciate any feedback. Thanks.
This practice for extension sets added to PICCs was addressed in the CDC guidelines many years ago, however it has been removed. The hub of the PICC is easy to get to without excessive manipulation of the catheter itself. The extension set and needleless connector should be changed at least weekly. PICC can dwell for extended periods and this set should not be allowed to remain attached without change the entire duration of the PICC. 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
There seems to be a misunderstanding of the studies on administration set duration that comes from the INS's use of conflicting terminology. The term "intermittent infusion" is generally understood to mean an infusion that is infusing intermittently, the term makes no reference to being intermittently connected or not. Many administration sets used for intermittent infusions are continuously connected, and there are times where a continuous infusion must be disconnected and then reconnected as line management needs dictate. Many of these studies excluded intermittently infusing administration sets since they may artificially lower the detectable contamination in the system, these studies occurred in otherwise unaltered clinical settings, so they likely included sets that were disconnected and reconnected.
Included in the CDC references on administration set changes were studies that show changing sets less often results in less introduction of bacteria, saying a set should be changed 24 hours after it is disconnected for some reason only adds an additional, unecessary set change, which increases risk to the patient rather than reducing risk.