At the hospital where I work the RNs have pretty much gotten away from labeling administration sets at all. I.V. therapy wants to change this practice. We're recommending labels with dat/time/initials placed just below the drip chamber. This makes the label readily visible enabling staff to determine when tubing needs to be changed. Critical Care staff and our Clinical educators want the label placed close to the vascular access device itself. Their purpose is to identify and verify correct med. infusing through appropriate site. This too is a valid need. I.V. therapy suggests 2 labels one close to the drip chamber and another close to the vascular access site. However this seems to have turned into a fierce debate. The critical care/ clinical ed. group feel it is too much to ask of the bedside staff RN to place 2 labels on the tubing. It seems that only one label placed close to the I.V. site would make it difficult to see the label without removing the patients covers and in some instances they may be lying on it etc. Please share where labels are being placed on administration sets at other facilities.
In addition the organisation has ordered color coded labels- red=arterial line, pink- enteral (tube feeding), blue= peripheral line, green= central line, isn't there some controversy about color coding these things?
If you are talking about a med labels..such as TPN/Lipids,Dopamine,Dobutamine and Heparin..this is what we do..we place one above the level of the pump..so yes it is below the drip chamber as described and one below the drip chamber closer to the site ( it is usually just distal to the y-site). We have always labeled the tubing above the pump..but decided to add the second one below the pump so if nurses hastily disconnect and reconnect another label may alert them what is infusing. We have had some situations where IV sets were taken out for various reasons and then were switched to the opposite pumps. These happened during emergency situations as is often the case. If you are talking about a sticker to indicate when a new tubing should be hung..we just place those above the pump and they are color-coded as another alert. I think it is critical to label all CONTINOUS DRIPS in some fashion and in a manner that will reduce errors
Placement of the label or use of multiple labels on one set may be a good idea, but it can never replace the need to always trace all tubing from one end to the other when reconnecting all tubing of any kind used for all purposes. The literature on misconnection of tubing has lots of details about severe mistakes when this is not done. So the labels will never replace this. Color coding is never to be used for directing therapy either as this has not been shown in studies to be effective. Reading labels, and following the line completely from one end to the other is the best method. Also, the constant message should always be to avoid discoonection of all continuous infusions. The only time it is appropriate in my opinion to discoonect a continuous infusion is when the tubing is to be changed. Disconnection for ambulating, going to the bathroom, changing clothing etc. dramatically increases the manipulation which increases the risk of contamination and the risk of misconnection. 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