IVPB antibiotics and saline locks....

[PinkNBlue]

If your patient is getting IV antibiotics but does not need to get IV fluids in between receiving antibiotics, do you get new tubing each time you hang the antibiotic (let's say it's supposed to infuse every 6 hours over 30 minutes)? So once that 30 minutes is up, you disconnect the IV tubing from the patient, leaving just the saline lock so you have access for the next dose and the patient isn't tied down having the IV running unnecessarily. New tubing? Or do you plug the end of the IV tubing into a cleaned port of the IV tubing? Just curious...

[MunoRN, RN]

I notice a few replies say that they change tubing for intermittent infusions q 24 hours. This is one reason why the INS annoys the $%^ out of me. The INS is unaware of the terminology used in infusion practice and refers to "intermittent" tubing as tubing that is intermittently connected, rather than intermittently infusing. The INS does not actually recommend changing intermittent tubing every 24 hours, yet this is how it is commonly understood, which actually increases contamination risk.

It's important to note that the evidence does not support this, in fact it suggests that this is bad practice. The INS claims that the many studies that showed additional or equal risk with less frequent tubing changes did not include tubing that was intermittently connected and disconnected although if you actually read the studies they clearly included intermittently connected tubing, they only excluded antibiotic tubing (for obvious reasons). Most studies showed no additional risk with less frequent changes, and 4 showed a significant increase in infections when tubing was changed more often, the INS recommendation defies this evidence without any evidence of their own to refute it.

[MunoRN, RN]

Current evidence shows that pre-hospital starts are just as good as hospital/ED starts. Back in the early 80's there was evidence the pre-hospital starts were more likely to be contaminated, based on a few studies all out of Charity Hospital in NOLA which involved a fairly small number of EMT's and Medics. Gloves were not typically worn, no skin asepsis was performed, and the IV was a metal needle just taped in place (no dressing). Today pre-hospital starts are held to the same standards as in-hospital starts, so the advantage of a new site needs to be weighed against the risks associate with a new start (introducing bacteria, nerve damage, vein damage).

[journey316]

Disconnect the line. Put a sterile cap on the end of the IV line. Flush the saline lock. The saline lock needs to be flushed again prior to next dose.

[OldnurseRN]

I think you are asking about the end of the tubing when the antibiotic is finished. You need to carry a cap with you to plug that end. Do not plug it into an unused port on the main tubing.

[Alice D Smith]

I was scared about that too, thanks for asking.

[kitty13]

Good technique! Yes always follow your hospital P&P but as Aurora77 said that 100ml bag is cheap, it delivers the rest of the antibiotic in the iv line to your patient so they get all the med. Even for intermittent this is best nursing practice and it clears your tubing of any residual med incase you are re-using tubing.