The issue of multiple secondary lines also came up in our attempts to update our policy. Bringing our policy up to date was again not only not helped but rather hindered by the INS.
The obvious question that comes up with the INS recommendations is why you would need to identify secondaries as "continuous" or "intermittent" (and why you would use terms that most would assume refer to a continuously running IV vs intermittently running, especially since the correct definition of a secondary is one that runs intermittently).
Correctly named "secondaries" should never be detached from the primary and should be taken down with the primary set. Even incompatible fluids can go through the same secondary with a proper backflush. Here's where the INS is not only fails to be helpful, but is actually just a nuisance. The INS makes no comments or even acknowledges, much less makes a recommendation on using multiple secondary lines vs using the same line for the purpose of maintaining a closed system. We found 8 different nursing fundamentals textbooks, all of which recommended the use a primary/secondary setup for intermittent infusions as well as the use of a backflush for priming as well as in between infusions. I wondered then why the INS seemed oblivious to these techniques. I noticed that their recommendations on IV tubing was based on only one source: Their own textbook. While the textbook was last published in the early 2006, the IV tubing and pump section had clearly not been updated since it was first published in 1974. The book only mentions IV pumps in passing as some sort of futuristic concept yet it does devote an entire page complete with pictures to the use and care of reusable glass containers that were apparently the precursor to plastic IV bags. This is why a basic premise of responsible of evidence based practice is to use outside sources and preferably more than 1, their use of evidence wouldn't earn a passing grade on an English 101 research paper.
Anyway, we weren't able to include in our policy that the backflush method is the preferred method and that we shouldn't be disconnecting secondary lines unnecessarily because we have a couple of nurses and a CNS who refuse to believe that the INS may not be the "authority" they claim to be. A true authority on a subject should have an answer to any question they are the "authority" of, or at least be capable of understanding and acknowleding the question when there is no known answer. By claiming to be the authority on infusion nursing, yet seeming to have no idea what the practice questions are much less the answers, we're left with a mish-mosh of good and bad practice with the only effect of the INS being as a roadblock to defining best practices.