I am aware that primary intermittent adminstration sets are to be changed every 24 hours (along with the "flush" solution). If a facility is affected by the critical shortage of 250ml solution bags and have temporarily allowed the bags to hang for 96 hours, should the administration sets still be changed every 24 hours or is it acceptable to change the administration set at 96hours when you change the bag? I would think spiking new tubing into an "old" bag would be more risk of infection than leaving the administration set for 96 hours, but I guess I would need evidence to support this.... Perhaps using a 50ml solution bag would solve this problem....
One more question... what should the flush solution be? I don't see a specific order for the solution and I have seen both D5W and NS used... I couldn't find anything in the standards unless I missed it.
Hope this all makes sense and thank you in advance!
No evidence to answer either question. Intermittent sets are recommende to be changed at 24 h because 1) they are manipulated with each dose on both ends, 2) the original research on admin set changes established 24 h as the recommendation, and 3) there is no evidence supporting longer use of an intermittent set. All studies on admin sets has been done with the continuous set attached and ONLY disconnected at the time limit. All admin set studies have omitted or specifically stated they did not address medication set infusion. For intermittent meds, are you disconnecting the carrier fluids after each dose and the set flushing? If so, this is added manipulation and added risk for infection, but no data on this practice whatsoever. Also no standard on what the solution should be. Some drugs are incompatible with NS and require D5W. Soe patients can tolerate one better than the other. Your pharmacy and therapeutics committee should establish the policy for this. The policy option are to have the LIP prescribe this fluid for each patient, or to allow pharmacy to choose the carrier solution appropirate for each intermittent med, or to choose one or the other. AGain no studies.
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