Does anyone change their propofol tubing Q24h?

[Murse_1]

Hi --

I'm looking into an issue related to the schedule for changing propofol tubing. I know most facilities change their tubing Q12h, but I understand that a small number of hospitals only require Q24. Does anyone work at a facility where this is the case? I'd be very interested in seeing the protocol or learning more about the rationale behind extending the schedule to Q24.

Thanks in advance..

[Reno1978, BSN, RN]

I was curious, once, about the 12 hour changeover for propofol and it's tubing. The manufacturer states this is required due to propofol's lack of preservatives and its ability to support the growth of microorganisms.

Unless something has changed, I'd say the 24H change is against manufacturer's guidelines and could potentially be an infection control issue.

[Sun0408, ASN, RN]

We do q12..

[Ruby Vee, BSN]

every 6 hours here.

[meandragonbrett]

We change it with every new bottle (we only use 50ml bottles).

[MunoRN, RN]

I was curious, once, about the 12 hour changeover for propofol and it's tubing. The manufacturer states this is required due to propofol's lack of preservatives and its ability to support the growth of microorganisms.

Unless something has changed, I'd say the 24H change is against manufacturer's guidelines and could potentially be an infection control issue.

I'm sure the manufacturer would prefer we changed it every 30 minutes including the bottle. Changing the tubing with every 50ml bottle seems excessive since typical vented tubing contains about 15ml in the line and in the drip chamber, if there is another 5ml left in the bottle when it's changed then just a little more than half of the propofol being used is actually making it to the patient, which I'm sure the manufacturer loves.

The CDC recommendation is at least every 12 hours, although it's not a super strong evidence base. The CDC lists only one source for their recommendation which was a study that found when anesthesiologists use the same bottle for an extended period of time and access it for multiple patients there is an increased infection risk, which is sort of obvious. The study in question did not evaluate tubing change frequencies. It's hard to say that these outbreaks would have occurred if basic precautions were taken, as the study points out; " Interviews with and observation of anesthesiology personnel documented a wide variety of lapses in aseptic techniques."

[Altra, BSN, RN]

I'm sure the manufacturer would prefer we changed it every 30 minutes including the bottle. Changing the tubing with every 50ml bottle seems excessive since typical vented tubing contains about 15ml in the line and in the drip chamber, if there is another 5ml left in the bottle when it's changed then just a little more than half of the propofol being used is actually making it to the patient, which I'm sure the manufacturer loves.

That's some really long tubing you must have. We only have one type of tubing - it contains a vent which can be opened for Propofol, NTG, or anything else in a bottle. End - to - end it holds about 4 mL.

[MunoRN, RN]

That's some really long tubing you must have. We only have one type of tubing - it contains a vent which can be opened for Propofol, NTG, or anything else in a bottle. End - to - end it holds about 4 mL.

Unless you're using microbore tubing, pretty much all IV tubing has approx 0.2ml per inch. We use duo-vent spike 106" tubing which lists a priming volume of 19ml. If your propofol tubing only has a priming volume of 4cc that would mean it's about 20" long which seems pretty short, even secondary sets are 40" and hold 9ml, do you use a small bore tubing for propofol?

[mochamonster]

Because I have an inquiring mind and wanted to know, I've taken a 10cc syringe and filled it sucking up left over fluid from our IV tubing including the cassette. That was not counting the drip chamber.

[Adenium]

Hmm...interesting. I only started using propofol when I moved to an ICU in January, and they change tubing Q24 hrs. I never looked up manufacturer recommendations because I was told that Q24 was the proper interval. Eek!

Perhaps something to mention to my nurse educator, though I'm not sure how well it would be received from a young newbie.

[libbyjeanne]

I was thinking about this the other night. At my hospital, we change the propofol tubing q12, but we only change the tubing to 20% lipids q24. I wonder what the rationale is behind that...

[Reno1978, BSN, RN]

I was thinking about this the other night. At my hospital, we change the propofol tubing q12, but we only change the tubing to 20% lipids q24. I wonder what the rationale is behind that...

Does the container you lipids come in contain volumes to deliver 24 hours worth of infusions? Where I work they do. Whereas with propofol, in a 12 hour period, I may go through several 100mL bottles. With spiking a new container with the same tubing, there is an opportunity to introduce microorganisms with each container change.

My thoughts, anyhow.