1.) Would you please state the length of time you allow your continously connected tubing to be in use (standard IVF not TPN, Diprovan, etc., like D5 1/2 NS)
2.) Please list your state
I'm curious to see if anyone has lengthened the time to 7 days and if there has been any correlation with an increase in infection.
q
4 days Texas
4 days Virginia
Robbin George RN VA-BC
4 days, NY
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
Our hospital still at 3 days-trying to convince Infection Control to go to 4 like CDC advocates. VERY frustrating. Massachusetts
One of the clinical sites our nursing students use change their secondary lines every 24hours but allow the primary tubing to stay for 72 hrs. If the secondary lines are treated like intermittant sets and changed every 24hrs, shouldn't the whole set-up, including the primary line, be changed every 24 hrs too?
No, the secondary piggyback sets should remain connected and the back priming method used, as long as there are no drug incompatibilities. This is the national standard established by the Infusion Nurses Society. If you practice as your reference recommends, those secondary sets are the ones being excessively manipulated with each dose of medication. Both ends are being opened and manipulated. The primary set is being entered but this would equate to entering the needleless connector on a catheter hub directly. Their policy calls for a change in the primary set too much at 72 hours, with both NS and CDC stating "No more frequently than 96 hours." Again the goal is to decrease the manipulation. I would make sure those students understand that this practice is costly (increases the number of secondary sets used) and not the recommendations of the INS SOP. I do understand that these students must follow the practices at this clinical site, but they must understand the differences. 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
Lynn, I am Trying to update our policy here. If the piggyback is back flushed completely. There should be no more "residual" in it than could be in the primary tubing through which all incompatible solutions are going to flow anyway? I am just thinking that if the thought is incompatible meds would preclude doing the back flush then is seems the suspected problem is residual from the previous med? Sorry, I hope that makes sense as I can saw it way better than I can write it. :)
We don't do back flush here. I am trying to implement it. We use a separate piggyback from each medication, and constantly access the primary line which has the first generation injection ports. (Another story) Or we use a primary line on each medication for intermittent fluids.
On my PICCs, I asked the nurses to use the second lumen (current generation access ports) on the PICC for injection of meds till we can get the new pumps that have newer gen ports.
I am a little confused by what you are asking. I am not sure what you are meaning by generation of ports??? For backpriming, the concern is compatibility between any medication added to the primary fluids and the seondary medication. You are holding the secondary fluid container lower to allow fluid to flow from the primary container backwards into the secondary piggyback set and then into the empty secondary fluid container. So there could easily be contact between these fluids which could cause a precipitate in the lumen. Common drugs in the primary fluid could be potassium chloride, heparin, insulin, aminophylline, or vitamins. I hope this has answered your question. 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
Regarding the generation of ports. I mean the port does not have a flat seamless top like our injection caps so it can not be cleaned properly etc.
Ok, I understand the primary fluids being compatible is the issue. The question was raised here about there being residual after the backflush that the new abx would not have been compatible. I didn't see that as being any more issue than the most of the main line having had the previous abx flowing through it. I understand now. Yes we would always ensure compatiblity with the back flush solution.
I want to include this in our new policy as decreasing injection port manipulation. Including not unhooking the line to slip the pt gown, etc.
Is there EBP for this type hub manipulation?
The warnings against hub manipulation is in both the CDC guidelines and INS standards. Additionally, the new book on CLABSI from Joint Commission addresses this idea of manipulation. Any study about hub management is really addressing manipulation although they might not use that word. 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
Our hospital follows INS's recommendation of changing each add-on device (secondary) with each administration set and PRN. Our policy states that if the IV is a continuous infusion, the tubing and secondarys should be "changed no more frequently than 96 hours" (INS 2011 standards page S95).
If the secondary is detached it should be changed every 24 hours (same page). This is also true that any intermittant IV (such as ones that are saline locked between antibiotics) should be changed every 24 hours.
It also goes without saying that any new line insertions gets all new tubing.
Propofol is a lipid based solution and you have to follow different guidelines page S96 states they shoudl be changed every 12 hours.
FYI, we have an EXTEMELY low rate of CRBSI.
Peggy
Peggy Hampton, RN
Clinical Education Specialist
Yuma Regional Medical Center
Pa. Continous infusion sets are changed Q 96 hrs. along with any secondary sets that are infused thru the primary (we back flsuh with our sets). Intermittent meds are adminsitered via a secondary set attached to a primary set and both sets are changed Q 24hrs including the solution. Hope this helps