A question came up recently in our PICU/CTICU regarding drips that are not infusing, but remain connected to the patient in the event that they would need to be restarted (in a weaning situation, for instance). My interpretation of the INS standards would lead me to believe that these still fall under the primary, continous administration sets and so should be changed no more frequently than every 96 hours, or when the medication itself expires. The standards do not address non-infusing tubing specifically, though.
Any suggestions?
Morgan Dunn, RN BSN CPON, Nutrition Support Nurse Clinician
Nationwide Children's Hospital, Columbus, OH
Well, our peds and neonatal reviewers did not provide any comments about this situation. As long as everything remains connected, it would fall into the same category as a primary continuous line. However change of the fluid container and sets would not be my main concern. With nothing infusing and nothing locking the catheter, there can easily be reflux and clotting leading to lumen occlusion. So I would question this practice of leaving everything connected but nothing infusing. I have never seen this in practice and certainly never seen any research about it. 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 for your response, Lynn. In regards to concern about reflux and occlusions - in the cases I described these drips would be y'd in with a carrier fluid or another infusion. So, when the drip is turned off, the drip line is clamped, but there is still something infusing through that lumen. If all infusions to a particular lumen are stopped, everything should be disconnected and flushed appropriately.
Morgan Dunn, RN BSN CPON, Nutrition Support Nurse Clinician
Nationwide Children's Hospital, Columbus, OH
Now I understand that you are talking about a secondary piggyback fluid container and set. Leave them connected and change at the 96 hour interval as long as they remain connected. 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
Is that narrative included in the Standards? I need to provide our pharmacy evidence for the safety of this practice. Thanks!
Yes on Administration Set Change. 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 get confused when it says 'administration set' and doesn't address fluid container. When the standards say administration set does that include the tubing and the fluid container (IV bag)?
No, it is addressing only the administration set. When you have a question such as this, look at the list of references to see the titles and you can probably answer your own question. There is not a standard on the max hang time for a fluid container, except for those prepared outside a laminar airflow workbench. See USP 797 requirements from your pharmacy. Most are still using the 24 hr limit for fluid containers but this has not changed since the 1970s. 2002 CDC labeled this as an unresolved issue. Eager to see what CDC2011 includes. 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