We are going to trial the new recommendation of doing Q 7 day IV tubing changes?  Any one else doing this? Notice any problems?

thought for the day

How do we change the hub of the central venous catheter.  We change tubing and needleless connections but what is in the HUB of the catheter.  Did you ever see that crusty blood in the hub or the crusty sugar build-up.  What is in the hub we never change?  How long is that catheter hub good for?

Thought fo the day

Kathy Kokotis RN BS MBA

Bard Access Systems

According to the Infusion

According to the Infusion Nursing Standards of Practice, a secondary or piggyback set should remain connected to the primary continuous set. If this happens, the entire system can be changed together no more frequently than 96 hours. Connecting and disconnecting these piggyback sets puts these in the intermittent set category and they should be changed every 24 hours. All studies on sets have either purposefully omitted data on these piggyback sets or not provided information about them at all. Therefore we have no evidence to use for their length of use. All sets used intermittently, being connected and reconnected with each dose should be changed by 24 hours as this was the original time established for use of all sets. Extending beyond this period has not been shown to be safe. CDC guidelines state to access all injection sites only with sterile devices. There is no data about the sterility of these sets after 1 use, much less several uses.

To decrease the number of secondary or piggyback sets used, you can consider use of the backpriming method - using the same connected set to give multiple medications as long as you have assessed compatibility between the secondary medication and any medications added to the primary fluid. Many hospitals will piggyback all medications into a saline infusion so they can do the backpriming procedure and not be concerned about medication from the primary fluid being incompatible with the secondary medication. 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

Regarding using an

Regarding using an administration set for 7 days, I would recommend getting information from these set manufacturers about their testing on use of their sets for up to 7 days. My understanding is that these sets have not been tested for this lengthy use. So there may not be an increased risk of infection but it could be possible for the sets to have mechanical issues when used that long. Before I tried it, I would definitelly get input from the manufacturer of the sets you are using. 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

secondary tubing changes

am at new facility,  they are changing secondary/piggy back tubing every 96 hours. however, the system is not a closed system.  The lines are connected/disconnected multiple times a day.  between uses the lines are left hanging loose on the pole, (not conneceted to anything) and other secondary  lines may be used to acccess the iv sites, ports and piccs.  I was in one room and there were 10 piggyback lines on the pole!

What is time line for length of use for these secondary/piggyback lines that are being connected/disconnected. 

Access technique, cleanliness is another issue at this facility

 

thanks

Janet Erickson

INS Standards re: IV tubing changes

You may want to look at that guideline again.  The CDC states, "no more frequently than at 96-hour intervals, but at least every 7 days."  I don't take this to mean the new recommendation is Q7.  Also, the INS Standard states "extending the administration set change to every 7 days may be considered when an anti-infective central vascular access device is being used or if fluids that enhance microbial growth are not administered through the set." 

~Stacy Ellis RN, BSW