Our department recently discovered the INS standard recommending iv tubing changes with any peripheal restart. Though I can see the reasoning of this it seems abit extreme not only in cost but also delaying pt treatment. How has everyone else implemented this? And is there a time parameter i.e tubing up less than 24 hours?
Thanks for any insight
Rhonda McHenry RN
IVT , Yakima,Wa
There is valid reasons for this, especially when you consider that up to 25% of PIV caths are contaminated based on cultures of the catheter upon removal. Taking an IV set from any PIV (that could easily be contaminated) to a new site is not wise. There are no studies that have established any time frame for when or if this would be acceptable practice. The cost of treating a PIV-BSI would far exceed the costs of changing the IV set. I know this is an area that is falling through the cracks as this type of infection is not included in the CDC reporting system from NHSN. However, your hospital would NOT receive any reimbursement for treating a PIV BSI because the hospital acquired conditions lists states "vascular access acquired infections". So this is not limited by type of infection or type of catheter. Also, I do not understand why there would be any delay of treatment due to this requirement. Maybe you can provide some additional information about that aspect. 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
Hello,
I'm wondering where I can review the reference you mentioned (up to 25% of PIV caths are contaminated based on cultures of the catheter upon removal). Many hospitals are not tracking PIV infection rates. I'm interested in looking at references in order to promote best outcomes. Many thanks for your advice!
Shelley Gallagher
thanks for the response Lynn, good info. My concern regarding delaying care assumes that when you change the tubing with eash peripheral restart,you also change the bag. If that is the case,then heparin drips, nexium and other pharmacy mixed and timed bags will have to be requested after the fact and that takes some time. I appreciate any comments or suggestions
What is the pharmacy policy for having the next compounded bag available on the nursing unit? 2 hours, 4 hours of infusion time left? All compounding services have such a policy. I would learn what that policy is and if the new bag is available when the catheter must be changed I would also change the bag. Obviously if it is not available, there is more fluid inside the bag to infusion than this time limit. You would have to use the existing bag. The problem with removing the spike from an infusing bag is allowing room air to enter, which could also allow for particulates and possible contamination. It does take some dexterity but you can pinch the outlet behind the spike before removing it then insert the new spike and prevent room air from entering. The bottom line is there is no research on the frequency of changing any fluid container, so there is no evidence to address this issue. 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, I will look into that. One last question on this topic! If the tubing is considered contaminated, isn't the bag it is open to also contaminated? Thanks again.
It might be but there are no studies that have demonstrated that. Usually the male luer end of the set is the primary concern for contamination and this would include the fluid in that lower section of the set. But whether the bugs have reached the fluid in the container has not been documented. Usually fluid and the container are contaminated by adding medication to it either in the pharmacy or on the nursing unit or by contaminating the spike as it was inserted. It drives me crazy to see nurses remove the cap from spike, then hold it in the hand that is also pulling the covering off of the outlet for the spike. Their hand rebounds when the covering breaks loose, the hand is waving all around and increasing the chance that the spike will be contaminated. The covering on the bag should be removed first, then remove the cap on the spike and insert it. Sometimes it is easy to drive the spike through the side of the plastic outlet, also contaminating it. It could be pushed further into the outlet occluding any leakage from the small hole but the spike was contaminated. Of course if there is any question about the color or clarity of the solution, the container must be discarded. But this usually takes a long time to occur. There have also been reports of fluid and container contamination when a bag of saline is used for repeated withdrawing of fluid for catheter flushes and this practice should never be done. So we truly do not know the frequency of contaminated fluid when changing the catheter and set. This happens so frequently I would think there would be reported clinical evidence if it were a problem. 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