In my experience, the commonly understood definition of "intermittent" tubing is a set that is disconnected at any time, and per the INS should be changed at 24 hours.
This definition is at least in part based on Lynn's explanation that it is the act of disonnecting the set that makes it "intermittent", although in a different thread Lynn pointed this out:
"Disconnecting the administration set for ANY continuous infusion is never recommended for any reason, but that alone does not alter the change to be a 24 hour set"
So what is the definition of "intermittent" tubing?
I think you have misunderstood a previous comment from me. An intermittent medication or infusion is one given for a short period eg 30, 60, 120 minutes, every 4, 6, 8, 12 or 24 hours. The set used to give these intermittent medications is known as a secondary piggyback set when attached to a primary continuous infusion set or a set used only to infuse this medication without any other fluids. These sets are manipulated on each end with each dose making them more vulnerable to contamination. No studies have been conducted on intermittent sets and no studies on continuous infusion sets have included medication or intermittent sets. Therefore an intermittent set used alone without any fluids or with only a carrier fluid to chase the med out of the set should be changed at 24 hours. A primary continuous set delivers fluids that are prescribed for continuous infusion and should NOT be interrupted, disconnected or stopped. The fluids and electrolytes are prescribed to be infused on a continous basis for days or even longer. Stopping this infusion would not be following the provider orders. These sets are changed based on the type of fluid being infused through them. For regular crystalloid fliuds this set is changed every 96 hours and new studies and the SHEA guidelines state it can be extended to 7 days. The secondary piggyback set infusing an intermittent medication should be connected to the primary set, never disconnected and the entire system changed together at the set time, either 4 or 7 days. Primary continuous sets are not disconnected from the VAD but there is no evidence and therefore no standard stating that this disconnection now changes this set to a 24 hour set.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
So "intermittent refers to whether it's infusing intermittently and not whether it's connected intermittently?
Secondary sets are not generally disconnected between infusions so I'm not sure what you mean.
And while every attempt should be made to avoid unecessary disonnections of continous sets, there are unfortunately times where it's unavoidable. The studies on the tubing set durations did not exclude continuous sets where these temporary disconnections occurred, so these have been studied. And you're correct that unecessary disconnections and connections of the set should be avoided, but saying that because a set was disconnected and reconnected for say, line traffic management, that it should then be changed 24 hours from that point just adds another unecessary manipulation of the connection, further increasing the risk of contamination. So are you saying that only sets that are left disconnected should be changed at 24 hours (prior to another reconnection)?
Yes, intermittent set refers to the intermittent medication and not being disconnected.
Some people do disconnect the secondary after the med infuses but they should not.
Studies on administration sets are all done on continuous sets, connected with a new bag to the VAD hub and never disconnected. No study included this practice of disconnection for any reason. I have a hard time with the idea that there are times when sets need to be disconnected. Gowns with shoulder snaps, running the bag and tubing through a sleeve the same direction as the arm are two very simple ways to prevent this. I don't know what you mean by line traffic management. Primary intermittent sets plus sets used for parenteral nutrition are the only ones that are changed at 24 hours., Lipids sets are changed at 12 hours and propofol sets are changed at 6 to 12 hours. Please read all these details in the INS SOP on Administration Set Management.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861