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Central Line Tubing Change

Posted
by jack4408 jack4408 (Member)

What is your hospital's procedure for changing IV bags and tubings for central lines?

texas2007, BSN, RN

Specializes in NICU. Has 2 years experience.

One person gets sterile, one non-sterile helper to open supplies, unwrap baby, hold and put the fluids in the pump. Both wear hat/mask. Do a complete line change (tubing, triple connector, hub caps) daily.

Imafloat, BSN, RN

Has 13 years experience.

We change our bags and lipid tubing every 24 hours. We change the other tubing every 72 hours.

iyqyqr

Specializes in NICU.

Our pharmacy puts all our tubings together and spikes the bags under a laminar flow hood and then they are brought to our unit on a cart. Each nurse checks the bags with the order and runs the fluids through all lines. Then after wiping the white cap with alcohol 10 times the old fluids are removed and new ones attached. No sterile gowns or masks and gloves are optional. I know last year we had a full year without a central line infection. So far this year, I believe we've had one.

littleneoRN

Specializes in NICU. Has 6 years experience.

Our pharmacy puts all our tubings together and spikes the bags under a laminar flow hood and then they are brought to our unit on a cart. Each nurse checks the bags with the order and runs the fluids through all lines. Then after wiping the white cap with alcohol 10 times the old fluids are removed and new ones attached. No sterile gowns or masks and gloves are optional. I know last year we had a full year without a central line infection. So far this year, I believe we've had one.

Gloves are optional?!?

Imafloat, BSN, RN

Has 13 years experience.

Sterile or clean?

Clean, when we change the male adaptor (every 6 days) we are sterile. We haven't had a central line infection in 2 years.

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

Clean technique unless we are changing the end cap,then sterile. We change TPN tubing Q72, IL Q24, med tubing Q72.

MegNeoNurse

Specializes in PICU, ICU, Transplant, Trauma, Surgical. Has 4 years experience.

New fluid bags Q24H, new tubing Q72H (as long as the fluid is the same, e.g. 3.2% AA w/0.5U/mL Heparin). If it is Hyperalimentation going through the UVC, then Q24H the tubing gets changed with the new bag of TPN and syr. of Lipids comes up.

Tubing is changed in a sterile fashion. When breaking the line, sterile gloves are worn, I always put the wrapper the gloves come in under my port.

NICURN29

Specializes in NICU. Has 11 years experience.

We change out TPN, IL, and any dextrose solutions Q24h, including tubing. We change out art line tubing q72h and the bags of art line fluids q24h.

For central lines, we use sterile technique, including a mask. However, we do it as a one-person job...no unsterile helper. For peripheral IVs, we use the same technique but no mask, unless the kid is under 1500 grams.

For those that use sterile technique (cap, gown, gloves and mask) or almost sterile (sterile gloves, mask) technique to change tubing, I am curious to know why you do this? Do you have any references, literature or textbooks that suggest to do it this way? I am a member of the Infusion nurses socitey and certified in infusion therapy, and never heard to do this. I have always taught clean technique for tubing changes, as the outside of the cathteter is not sterile anyway, and the tubing and anything hanging is not sterile on the outside once it is hung. As long as you wear clean gloves and throughly scrub the connection valve/cap at the end of the catheter, clean technique should be sufficient.

Thanks for sharing your references, if I need to update my technique.

UTVOL3

Specializes in NICU, adult med-tele. Has 6 years experience.

Clean, when we change the male adaptor (every 6 days) we are sterile. We haven't had a central line infection in 2 years.

Wow! This is awesome. Did you have a high rate of infection prior to this? Were there any specific changes you think helped contribute to a zero infection rate?:yeah:

NIGHTWOLF87

Specializes in NICU, Psych, Med/Onc,Ped Home Health. Has 6 years experience.

we change our tubing q24hrs on all of our lines, central and peripheral. we use sterile technique to change our central lines, and all tubing and iv fluids are changed on day shift (7a-7p). on nights we change out the beds and weigh the infants, except the most critical, or course.

OK, do you have any references in literature or texts to guide this practice? Did you collect evidence in your hospital that let you to change tubings using sterile technique and more often than the CDC guidelines, which state every 72 hours? I am aware that some NICUs and PICUs do this, I am trying to find out the "why" and see if there is evidence to support this. I have only found studies that suggest there is no need to do this, including the CDC guidelines. Thanks

babyNP., APRN

Specializes in NICU. Has 13 years experience.

I have to agree with the above. The tubing that you're touching with your sterile hands isn't sterile...so why would you do it that way? On my unit, we don't use sterile gloves, but obviously the connection is sterile...

UTVOL3

Specializes in NICU, adult med-tele. Has 6 years experience.

I know in our hospital they specifically told us there was no evidence to support the sterile glove/mask/hat deal when changing out fluids on central lines. However, we were to do it anyway. They were just at a loss for why we had so much coag neg staph. Seriously they were about ready to try voodoo or something if they thought it'd help.

Personally I always suspected something was up with the way they classified the infections. Never found out, I have been gone from there for a year now. Don't know if they ever figured it out.:yawn:

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