I have a question for you. One of my field nurses was going to a patient's home to do her weekly port a cath needle change and was changing the tubing as well. The patient is receiving Morphine PCA. ( Basal rate and bolus dosing). So it is considered a "continuous infusion". However, when she went to change the tubing, the bag of Morphine was still half full. She wasn't sure what to do with the bag and called our pharmacy. The pharmacy instructed her to respike the bag with the new tubing to allow finishing the bag of Morphine. My response to this was that she should have spiked a new bag of Morphine because respiking the old bag is risk of contamination. I looked everywhere in the INS standards to back up my advice and while INS standards state that the administration set should be changed, nothing is stated regarding the bag. I was always taught that the bag becomes part of the administration set, therefore, when you change needle and tubing.....bag of infusate would be changed also.Â
Our pharmacy mixed up a bag that would last for 10 days (they said Morphine is stable for that long) but you would think that they would only make up enough to last through the weekly port needle change so everything would be fresh when the nurse went to reaccess the port with new needle and tubing.
With a closed system, such as this( port a cath with no other therapies being prescribed)Â the tubing and needle (with bag change) is ok once every 7 days, correct?
I would love anyone's input on this please!
I work for a home infusion pharmacy and it is our policy that everything is changed every 7 days. We spike our bags in our laminar flow hood so everything is sterile and send to the patient that way. However, on some of our hospice patients it is not cost effective (to the hospice agency if half a bag is left) to mix more med and send. In cases like this the connection is never broken except for when the needle is changed. We always try to see how much the patient is using and at the next refill see if we can lower our total volume. We usually never go over 10 days. Knowing what I know about USP 797 I would not respike a bag in the home. I would feel safer leaving the tubing intact and keeping a closed connection.
Amy Tilghman,RN Vital Care