A discussion as come up at our instituition regarding maximum time to leave IV normal saline flush bags up.  Our current policy is 24 hours but some nurses want to change that to 96 hours to match the tubing administration set change.  The way I read INS standards is 24 hours max unless some strict criteria are met (i.e. no injection ports in the administration sets).   This about eliminates most flush bag systems.  Our ICU nurses say that "No one changes the invasive monitoring pressure bag systems every 24 hours"  Is this true?  What are other iinstituitions doing?  By the way, our infection control nurse read me the CDC guidelines and they were inconclusive.

extended TPN hang time

I find it a bit concerning as the people aiming to increase the time, are thinking only of infection possibilities and the two papers that have mentioned it, did not say whether the vitamin and minerals remained stable. Their only comment was that infection rates didnt increase.

Maybe if the connections were connected in an ANTT method, would help, but it seems that sloppy still seems to be an active problem so often,  that the chance of infection will mean  it will be something really massive, in what surely is an already compromised patient.

Having communication with parents whose children are on long term PN, they are not very happy when its been suggested that their children can swap, to the longer hang times.

 

Hang-TIme for PN

I am wondering if anyone is aware of increasing the hang time for Parenteral Nutrition - there is a move for some groups to leave PN in place for 48 hours without changing the bag - any comments?

Karen Rankin

Clinical Nurse Consultant

the Children's Hospital at Westmead - Australia

This should be established in

This should be established in hospital policy and procedure and NOT an individual preference. It will add cost so all factors must be considered at the organizational level. It can be acceptable practice although I am not aware of any published studies on its use of outcomes. It is NOT a recommendation from INS or any other professional organization that this is the preferred or best method. As I said, there are no studies to support its use. Backpriming the intermittent set and having fluids that will allow the nurse to return at her convenience to disconnect the set from an intermittent catheter are the 2 primary reasons. If you only have the intermittent med infusing, then the nurse must return promptly to disconnect and flush the line. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

flush bags

How many facilities use the flush bags?  Does this have to be a facility policy or individual preference? Is this an acceptable practice Lynn?  I always thought it was a good idea to get all the medication and clean out the line that will now sit there for 6-8 hours. 

Is it an INS recommendation that an  intermittent infusion should be set up to include a primary flush bag?  Is this to infuse all the meds or back prime the intermittent tubing?

cherie

By "flush bag", I am

By "flush bag", I am assuming you mean a bag of saline dedicated to one patient to which their intermittent medications are piggybacked. This bag of saline, also known as a saline carrier, is then connected and disconnected from the patient's IV catheter as needed based on the frequency of each medication.

The bag along with all tubing that is connected and disconnected from the catheter on a routine basis should be changed every 24 hours. The reason for this is the fact that you are manipulating that tubing more frequently than any continuous tubing. Also there is absolutely no studies that I have ever been able to locate that have examined the length of time before intermittent tubing is contaminated and no longer acceptable to use. Because of this total absence of evidence and the frequent manipulation, the standards state to change this tubing at 24 hours.

 The maximum hang time for a bag of IV fluids has always been 24 hours, although the CDC now calls this an unresolved issue because there are no recent studies on it. Again INS takes a conservative approach in the absence of these studies to leave this change interval at 24 hours. 

The difference between these venous systems and an invasive monitoring pressure bag system is that there is not nearly as much manipulation of the system. You are not connecting and disconnecting from the catheter nor are you attaching piggyback med tubing to the intraarterial system. Therefore, the standard for this closed system is 96 hours but any system that is frequently manipulated is 24 hours. Lynn 

 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861