Do you leave your med/flush tubing up?

Specialties NICU

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Do you disconnect your tubing after each med and flush, or do you leave your set up there for X amount of hours? Also, does anyone use the trifurcated connectors with the filter built onto one of the tails? TIA

Specializes in NICU level III.

In our unit after the med is given we throw it all away. We don't reuse tubing what-so-ever.

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Specializes in Level III NICU.
In our unit after the med is given we throw it all away. We don't reuse tubing what-so-ever.

Ditto. And all IV solutions and tubing, regardless of what they are, get changed q24.

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Specializes in NICU.
Ditto. And all IV solutions and tubing, regardless of what they are, get changed q24.

How are your CLASBI rates? I know our protocol was a specific attempt to lower ours, which were really high. I guess the theory is that opening the line up over and over to detach/attach new med tubing was a bigger risk than re-using the med tubing.

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Specializes in NICU.

I have been surprised to see the high CLASBI rates in many of the NICU's I have traveled to AND the elaborate methods tried in an effort to decrease the rates. My home unit line infection rates have always been very low and to date we have gone 244 days without a line infection! All of our tubing and y'd in drips are assembled in pharmacy under a laminar flow hood and they and solutions are changed every 24 hours. When the fluids arrive on the floor we simply prime and hook them up to the pt. We don't gown or glove, we have no med bags, just an extension tubing for meds which is capped and the meds are given and then we flush with 3ml syringes of NS, which are to be tossed after each use. We have an excellent nurse in charge of our lines and protocols and she feels it is many little details that combine to provide a low infection rate. I'm presently working in a unit where the only meds that can be given in central lines are aby and only if the line had a positive culture. All other IV meds are given in PIV's and I feel like I have returned to nursing in the 80's. The babies look like pincushions!!

How are your CLASBI rates? I know our protocol was a specific attempt to lower ours, which were really high. I guess the theory is that opening the line up over and over to detach/attach new med tubing was a bigger risk than re-using the med tubing.
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Specializes in NICU.

We must be the only ones that never re-use med tubing. They do it in the PICU but we don't in the NICU here. We use fresh tubing every single time and disconnect it after the med is done infusing.

Our IV tubing for fluids and drips is changed every 96 hours, except for lipids which gets a new bag and new tubing every 24 hours. If it's something factory-made, like heparinized saline or plain D10W, we can leave the same bag and tubing running for 96 hours. If it's made by the pharmacy, like hyperal or drips, a new bag is spiked or a new syringe is hung each day, but using the same tubing for 96 hours.

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Specializes in NICU.
I'm presently working in a unit where the only meds that can be given in central lines are aby and only if the line had a positive culture. All other IV meds are given in PIV's and I feel like I have returned to nursing in the 80's. The babies look like pincushions!!

Pardon my language, but that is the dumbest damn thing I've ever heard. What do they do with dopamine? K runs? Have these people never seen what extravasated epi will do to a limb? :banghead: I'd last about ten minutes on that unit. I salute you for being a better person than I.

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Specializes in NICU.
Pardon my language, but that is the dumbest damn thing I've ever heard. What do they do with dopamine? K runs? Have these people never seen what extravasated epi will do to a limb? :banghead: I'd last about ten minutes on that unit. I salute you for being a better person than I.

Dopamine would be a drip and is y'd in with the Hal and Lipids , K would be given PIV and watched very carefully. All IV push meds and aby are given PIV except when the line is infected. This has been very hard for me to accept, esp since this is one of the top NICU's in the nation. They also gown, hat, and mask to prime or if they enter the CL, BUT use clean gloves and put all supplies on a CLEAN chux. Their infection rates were high, and I have some ideas why. After much discussion this is the protocol they arrived at and I feel the pt has paid the price. I haven't flushed so many PIV's since the early years of my 26 year NICU career. And this with a Broviac or PICC in place. Most babies have two and the sickest ones three PIV's. And with adult, not neo trifuses; oh, and all PIV's are on arm and footboards. Can you imagine trying to nest one of these pts? I have also been surprised that many units use the adult, red, white and blue trifuses. Do they not know that there are sweet neo brands, so our tiny ones aren't weighted down?

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Specializes in NICU/Pediatrics.

That would make me insane.

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Dopamine would be a drip and is y'd in with the Hal and Lipids , K would be given PIV and watched very carefully. All IV push meds and aby are given PIV except when the line is infected. This has been very hard for me to accept, esp since this is one of the top NICU's in the nation. They also gown, hat, and mask to prime or if they enter the CL, BUT use clean gloves and put all supplies on a CLEAN chux. Their infection rates were high, and I have some ideas why. After much discussion this is the protocol they arrived at and I feel the pt has paid the price. I haven't flushed so many PIV's since the early years of my 26 year NICU career. And this with a Broviac or PICC in place. Most babies have two and the sickest ones three PIV's. And with adult, not neo trifuses; oh, and all PIV's are on arm and footboards. Can you imagine trying to nest one of these pts? I have also been surprised that many units use the adult, red, white and blue trifuses. Do they not know that there are sweet neo brands, so our tiny ones aren't weighted down?

OMG, this would drive me insane. Have the powers that be realized how much trauma they are causing these patients by all these IV sticks? Do you ever run out of veins? Those poor babies must be so uncomfortable, I can't imagine trying to position a baby with IVs on the majority of it's limbs. I think that maybe your admin has forgotten about other aspects of comfort and care.

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Specializes in Neonatal ICU (Cardiothoracic).

I would never be able to work in that unit. There are some things I will not tolerate in a unit, one being asinine policies that cause patients harm for no forseeable benefit....

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We leave our tubing up. If you are only running clears, the tubing is good for 72 hours. Everything else gets changed q24. So basically, everything gets changed q24 because we barely have a kid on jsut D10. Our infection rates have gotten a lot better, but still aren't up to snuff...I think we are talking about doing less tubing changes. 96 hours sounds awesome!

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Specializes in NICU.

We were just discussing our policy on tubing yesterday. The ONLY tubing that's left up for longer than 24 hours is TPN. All drips and lipids are Q24 changes. Things like antibiotics are tossed when the flush is done...even when there's another going up right after it.

I know I'm new, right? So I'm not into irritating the war horses in my unit, but can someone explain WHY the TPN/Lipid change is sterile, when starting an antibiotic (or whatever) on the other side of the Y isn't? Why they give you the "tisk, tisk" lecture about accessing the lines too often, but then change med tubings 4-5 times a day?

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