I recently transferred to IP at one of our smaller hospitals and I'm updating IV-related policies. I'm looking for information regarding when to change-out infusions--a recommended hang time. Perhaps this lives in pharmacy policies?
This statement in the nursing IV policy doesn't satisfy me: "All opened/spiked IV continuous infusions are to be disposed of after 72 hours and replaced with new containers" I'm interpreting this to be a continuous primary infusion is changed with the administration set (96 hrs). For a single bag to hang for 96 hrs, it would be at a KVO rate.
Blood, lipids, PN, propofol, insulin, chemo and intermittent and primary administration set changes are addressed in the policy. It also addresses hanging new fluids with the 96 hr admin set change.
When I worked bedside, we changed the KVO bags every 24 hrs. Is the practice now to change continuous infusions when they empty or with the administration set change--whichever comes first?
(My attempt to post to the INS discussion failed.)
First, there is no established rate that will keep a vein or catheter open and patent. There are many, many more factors involved with lumen patency than just the flow rate. Also there is no data to my knowledge comparing a slow flow rate to a locked lumen. The locked lumen would give more freedom for patient movement between intermittent infusions.
There is no recommended max time for any fluid container to hang. It had been a max of 24 hours since the 1970's but CDC took this out of the guidelines many years ago, probably around 2002 edition. There is a statement from ASHP from a few years back when there was a severe and ongoing shortage of common IV fluids. In 2015 I gave a presentation at APIC about the unanswered questions for infection prevention in infusion therapy and this container hang time was one of those questions. So, no standards or guidelines give a specific time limit. The shortages have cleared up. So your facility must assess your facility, staff, and patients for risk factors and make a decision. See INS Standards Parenteral Medication and Solution Administration for a few statements about this, 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
Thank you Lynn,
I removed that statement from the policy. I freshend-up the section on admin set change: change primary continuous administration sets no more freq than 96 hours unless the type of infusion requires a more frequent admin set change (listed the most common) and when possible to coordinate the hanging of new fluids with a new admin set.
Deb
You never know. Studies are being done in Australia and it could be that the bag might not grow out anything for an extended period like 96 hours. But then I would have to ask what is the flow rate that would allow a 1000 mL bag to infuse for so long and if it is only going that slowly why is the fluid needed at all? 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