Policy on IV tubing/bag change?

  1. I'm in a new unit and their policy on changing iv tubing/bags is different from where I worked. I looked up CDC guidelines (actually googled it and got sent to another site but it seems legit) and the recommendations seem little contradictory. Here's the site for anyone who is feeling motivated!

    4.5: Prevention of IV Related Infections


    The basics are nothing new: change tubing q 72 hours, maintain a closed system, etc.

    Then it says that Large Volume Parenterals should be used up or discontinued if not completed in 24 hours.

    Large volume is not defined...is that the 4L bag of TPN (obviously) or the 50cc bag of epinephrine? What about the 250cc bag of epi?

    My issue (and maybe it's just me...my previous institution changed everything: bags, tubings, stopcocks, q 72 hours except for TPN) is that if you change the bag q 24 but change the tubing q 72 aren't you breaking that closed system? If your base solution isn't dextrose, it seems that by unspiking, then respiking a new bag, you have a greater risk for introducing infection than if you kept it closed.

    Any thoughts? Any other websites I can check?
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  2. 32 Comments

  3. by   clemmm78
    We changed bags q24, tubings q72 in the hospitals I worked. I wouldn't want a bag hanging longer than that, and if you are hanging the bag the way we're supposed to, keeping the area sterile, I dont feel you're introducing any risk.
  4. by   augigi
    I have always been taught that TPN is in a class of its own and must be changed (bag and tubing) q 24hrs, along with other high-lipid solutions such as propofol. There is lots of evidence about prevention of CVC infections - is this what you are talking about?

    This website (NGC - NGC Summary) says: A - In general, administration sets in continuous use need not be replaced more frequently than at 72-hour intervals unless they become disconnected or a catheter-related infection is suspected or documented.
    D - Administration sets for blood and blood components should be changed every 12 hours, or according to the manufacturer's recommendations.
    D - Administration sets used for TPN infusions should generally be changed every 24 hours. If the solution contains only glucose and amino acids, administration sets in continuous use do not need to be replaced more frequently than every 72 hours.
  5. by   k3immigrant
    in my facility, we change diprivan drip iv tubing q 24 hrs, tpn bags are for 24 hrs so when new bag means new tubings & the rest is 96hrs.when i come on & my tubings are not labeled, i change it.it's time consuming to change tubings but it's worth it when you think about the ID md ordering to pull the PICC or the central line because the pt is septic or the pt has bacteremia, fungus etc.
  6. by   Marie_LPN, RN
    Where i work, bags and tubing are changed q24hr.
  7. by   NessaNurse
    Where I work as well all bags, tubings ect are changed q24 h. Unless the bag is never entered (*ie no IV push meds, no entring w syringe pump, no piggy backs ect) it can stay for 72 h. So most everything is changed q 24
  8. by   muffie
    Quote from clemmm78
    We changed bags q24, tubings q72 in the hospitals I worked. I wouldn't want a bag hanging longer than that, and if you are hanging the bag the way we're supposed to, keeping the area sterile, I dont feel you're introducing any risk.

    same with my hosp
  9. by   km5v6r
    Tubings at my hospital are changed every 96 hours unless it is Albumen, Lipids or Propofol. Manufacturer mixed IV's are changed every 48 hours, again, except the previous, and pharmacy mixed IV's every 24 hours. The unit has bright colored labels stating "change on Tuesday" etc. There is a different color each day. It is much easier to tell at a glance if the tubing is due to be changed and increased compliance with labeling.
  10. by   Tweety
    Fluids/medication of anysort that remain are changed q24h. TPN tubing q24. All other tubing q 96.
  11. by   P_RN
    Do you strip your bags as to fluid/time started etc? Not tag tubing but that ruler looking thing you put on vertically?
  12. by   Tweety
    Quote from P_RN
    Do you strip your bags as to fluid/time started etc? Not tag tubing but that ruler looking thing you put on vertically?
    I haven't seen those things in 10 years.
    We use the tubing labels like the person above that say "change Friday", etc. There is a time, but just make our night shift do it on that day no matter what time. At least that's the policy. They rarely do it and people rarely is ever label their tubings, but for when JACHO is near....sigh.
  13. by   muffie
    we use pumps for most things
  14. by   jill48
    Quote from Tweety
    Fluids/medication of anysort that remain are changed q24h. TPN tubing q24. All other tubing q 96.
    96 hours seems too long. I've never heard of that before. I have always changed bags q 24 hrs and lines q 72hrs. Alot of the times I would just change the tubing along with the bag; I think that is the safest whether it is policy or not.

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