What's your facility's policy? new PIV tubing to new CVL

[ANB RN]

Situation:

Pt CABG/AVR/septal myoectomy POD 4 or 5. Pt on Heparin, Amiodarone pulls out PICC line at 0000. BP starts to decrease 80s/40s. You need to start Neo. PIV x 3 started- all bags/IV tubing changed. As pt's chest becomes unstable (popped a wire or two) and starts to bleed. At 0300, PA comes in to place central line.

Does your facility require you now change bags/IV tubing again after only three hours because it is a new line? One co-worker said it is a must due to CLABSI risk. (I could understand that if the hubs were not scrubbed appropriately or previous lines were old). I could not find any policy from my employer or a study that substantiates claim of increased risk.

Please tell me what your facility requires or links to any studies you might have read on the matter. Thanks.

[meandragonbrett]

No. We do not do this.

[Sun0408, ASN, RN]

We do.. New PICC or TLC = new bags and new tubing,every time.. No links to provide for you, this is company policy.

[chare]

We do as well. Alhough our policy only requires new tubing, I am not aware of any of my cow orkers that do this.

You might consider posting this in the Infusion Nursing / Intravenous Nursing area.

[umcRN, BSN, RN]

We never go peripheral to central, we always string new bags and tubings though I don't have any links, but it is in our policy so I could probably dig some up if I had a chance.

[MunoRN, RN]

There are no studies or evidence to support this. The INS recommends new tubing, I can't remember if they recommend changing bags as well, I'd refer you to their standards but for some reason they like to keep them secret.

We change tubing, but not bags, with a new CVL but only when going from peripheral to CVL.

[Lennonninja, MSN, APRN, NP]

We can never move tubing from a peripheral line to a central line, we have to change the tubing and the bag if we are switching to a central line to decrease the chance of infection.

[WoosahRN, MSN, RN]

Yes. New tubing and syringes or bags for a central line. It's part of our CLABSI protocol. And any meds or fluids being given via extra PIVs don't cross over to that central line during care so we label that tubing as PIV.

[coupb8222]

Yes Policy regardless if central or peripheral. NEW LINE = NEW TUBING/MEDS. This should be under your policy, I think it would be bad practice to spike the old bag with new tubing? You need entirely new set up.

However, if the patient's blood pressure was 80/40 and they are symptomatic, you need to think about life saving measures first. Think of the time it takes to get new medication IV bags from pharmacy and get everything set up, you may just have a code blue on your hands. If my patient was symptomatic and crumping i'd hook up the "contaminated" lines, after the situation normalized, I would switch over to new meds and new tubing to be in compliance with the policy. Benefits of giving the med with the 3 hours line with symptomatic low blood pressure, versus - withholding meds just to get new tubing. We have to critically think. Of course when situation normalizes, hang new tubing.

If you don't have a policy really you should speak with your policy and procedure committee.

[brewski09]

If my patient was symptomatic and crumping i'd hook up the "contaminated" lines, after the situation normalized, I would switch over to new meds and new tubing to be in compliance with the policy. Benefits of giving the med with the 3 hours line with symptomatic low blood pressure, versus - withholding meds just to get new tubing. We have to critically think. Of course when situation normalizes, hang new tubing.

If you don't have a policy really you should speak with your policy and procedure committee.

If the concern here is whether we have just contaminated his central line or not, will changing to new tubing/meds make any difference? I think hanging the old tubing is the right action here because you have to save the life first. But if you do happen to have a CLABSI event, changing to new tubing after a couple of hours won't stop that, the damage is already done. This is like the emergently placed line in an emergency Deparment. It should probably be removed and replaced (it may have been emergently placed anyway and require replacement)

[Mer817]

In my facility it is "new lines = new tubes (and bags of course.) regardless of how old the previous tubings are.

[cabgnurse]

I agree with some of the prior posts. Our policy is also "New to new", but if the patient is dying, time does not permit stringing new tubing. You can't have a CLASBI if you have expired. Hopefully your teammates could step in and help in a scenario such as this.