Do you change your TPN tubing Q24 or Q72??

  1. At my last job in the NICU, we changed our TPN tubing Q72 hours, this seemed to help our infection rate. At my new job we change it Q24 hours. We have a problem with infections in the new unit. Of course the TPN itself is changed Q24, I'm just talking about the tubing. I'm wondering if breaking into the line Q24 is not a good idea.
    If you have any literature supportng Q72, could you please let me know?
    I'm trying to give my manager some clinical evidence.

    Thanks
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  2. 33 Comments

  3. by   dijaqrn
    Where I work the standard for TPN tubing is q 24 with the bag because of the glucose content of the solution!!!!!!!!
  4. by   augigi
    According to the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections:

    Peripheral venous/midline catheters: Replace intravenous tubing, including add-on devices, no more frequently than at 72-hour intervals unless clinically indicated. Replace tubing used to administer blood, blood products, or lipid emulsions within 24 hours of initiating the infusion. Complete infusion of lipidcontaining parenteral nutrition fluids (e.g., 3-in-1 solutions) within 24 hours of hanging the fluid. Complete infusion of lipid emulsions alone within 12 hours of hanging the fluid. Complete infusions of blood products within 4 hours of hanging the product.


    Central Venous Catheters/PICCs: Replace intravenous tubing and add on devices no more frequently than at 72-hour intervals. Replace tubing used to administer blood products or lipid emulsions within 24 hours of initiating the infusion. Complete infusions of lipid containing fluids within 24 hours of hanging the fluid.

    http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf
  5. by   P_RN
    CDC recommendations only address TPN lipid content and that is to change the tubing q 24h.
    Erratum: Vol. 51, No. RR-10
  6. by   2curlygirls
    We change ours q96
  7. by   RainDreamer
    All TPN/lipid tubing is changed q24. If they're deep lines it's done under sterile technique .... and our infection rates have gone down since changing to sterile technique.
  8. by   MA Nurse
    Quote from dijaqrn
    Where I work the standard for TPN tubing is q 24 with the bag because of the glucose content of the solution!!!!!!!!
    Yes, I know. We change our bags and tubing BOTH Q24. Where I used to work we changed the TPN bag Q24, but the tubing was changed Q72.

    Please re-read my original post if you don't understand my question.

    Thanks!

    Kim
  9. by   MA Nurse
    Quote from P_RN
    CDC recommendations only address TPN lipid content and that is to change the tubing q 24h.
    Erratum: Vol. 51, No. RR-10
    Thanks for the link. It says to not change the IV tubing more frequently than every 72 hours, so that definately answers my question! I'm going to bring this to work.

    Kim
  10. by   nurse4theplanet
    On my unit (MS ICU) we change the TPN q24hr and new tubing with each new bag, so new tubing q24 as well.
  11. by   augigi
    Quote from Kimbalou
    Thanks for the link. It says to not change the IV tubing more frequently than every 72 hours, so that definately answers my question! I'm going to bring this to work.

    Kim
    Actually, no it says any lipid containing solutions should have the administration set changed q24hrs.
  12. by   RazorbackRN
    Quote from Kimbalou
    Yes, I know. We change our bags and tubing BOTH Q24. Where I used to work we changed the TPN bag Q24, but the tubing was changed Q72.

    Please re-read my original post if you don't understand my question.

    Thanks!

    Kim

    Ummm...I think she answered the question correctly. They change bag + tubing q 24.


    Q24 is also done at our facility, per CDC recommendations.
  13. by   morte
    in the several places that i have worked and hung TPN, including home care, it was ordered in 24 hour increments...NEVER to run longer than that, and, of course NEW tubing was used ea time......
  14. by   nell
    Maybe some of the confusion as to what the CDC guidelines mean has to do with how the lipids (change Q 24 hours) are infused.

    In any NICU I have ever worked in, the TPN and Lipids are separate bags and tubing. Therefore, per the CDC guidlines, the TPN tubing is changed Q 72 hours and the Lipid tubing is changed Q 24 hours. (Bags for both are changed Q 24 hours.)

    In other settings, I have seen the 3-in-1 solution in which the Lipids are mixed in the same bag as the TPN. In this situation, since there are Lipids in the tubing, the recomendation is to change the tubing Q 24 hours.

    nell

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Do you change your TPN tubing Q24 or Q72??