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Judybeth
Extension set change with propofol tubing

Hi, my hospital has just switched from the Baxter interlink to the Baxter onelink with extension. I know most hospitals changed from the old interlink system long ago, but we had been happy with it so it took us awhile. Here is my question: Our protocol has always been to change propofol tubing every 12 hours. We did not change the cap when we changed the tubing. I am wondering what is the practice with extensions out there when changing propofol tubing? Do you leave the extension and cap and just change the administration tubing every 12 hours or do you switch out the extension too? Prior to this switch we used extensions but it wasn't a common practice to do so on every patient. So culturally and procedurally this is a switch for us to have an extension on every line. 

Thanks

lynncrni
Some brands of propofol need

Some brands of propofol need to have set changed every 6 hours, others every 12 h. I am a strong proponent of extension sets on all PIVCs. I am assuming your are asking about infusion through PIVC. The issue is certain fungal organisms growing in the propofol. Small amounts of propofol left in the housing of stopcocks has been linked to BSI. I would recommend changing the whole infusion system. But then the issue becomes what does manipulation at the PIVC hub do to catheter dwell time and complication rates. And there is no evidence-based answer to that question. If using some new PIVCs (eg Nexivia, Deltaven) the extension set is permanently attached and cannot be changed without removing the catheter. Have you discussed this issue with your infection prevention dept? 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Judybeth
Okay, thanks. Our propofol is

Okay, thanks. Our propofol is an every 12 hour tubing change. Sorry, I didn't specifiy but yes, I am talking about a PIV. Previously, with the old interlinks we changed the tubing q 12 and only changed the interlink cap when we need to restart the line. We have never had fungal infections on our propofol lines in the past and we definately do not want to do anything that would change that. For infection control reasons we feel we should either change the extension or not place an extension on the catheter at all. We have concerns about taking all the tubing and extension down to the hub every time we change the tubing because, even briefly, the exposed hub open to air could also lead to infection, the manipulation of the catheter that close to the hub could cause problems when unscrewed q 12 as you point out, and lastly because a vein with a very robust blood return can be difficult at times to tamp off during the change and leads to an increased risk of blood exposure to the ICU nurses when they change everything. I can check with infection control and see what they think but this type of question often gets fielded to us in IV therapy by them. I was wondering what the practice was at other facilities. Thanks again for your input.

lynncrni
Agree with all except opening

Agree with all except opening the hub and exposure to air as a risk. No evidence of that, but manipulation can easily lead to touch contamination. Good luck. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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