Fluid Changing practices

Specialties NICU

Published

Hi All,

I was wondering what everyone did when they changed their TPN/IL. How often do you change the tubings, how do you change the tubings, etc.

We:

1. Change TPN q24 and IL q12.

2. Lines are hung "cleanly" as opposed to sterilly. Honestly I think they are changed dirty because we don't use any sort of sterile field, just the packaging the tubings come in, and we change them and then walk across the room to hang them, rather than just hang them at the bedside.

3. We use a system that has a trifuse that directly connects to the PICC/UVC/PIV, etc. and then the IL tubing and TPN tubing connect to the trifuse. We change the tubings q24, but the trifuse q72. We are thinking we should change everything q24.

Thanks in advance for any feedback you can offer.

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Specializes in Neonatal ICU (Cardiothoracic).

Try running an AN search on this topic.... we've discussed it pretty recently, and a lot of people had some great ideas...

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Specializes in NICU, PICU, PACU.

Steve's right. I think that the CDC says 72 hours is fine for most fluids. We leave our TPN line for 72 hours, med tubing 72 hours and the IL line is only 24. We change ours at the bedside, why wouldn't you?

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We don't hang them at the bedside because aesthetics are more important to my managers than anything else.

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Specializes in NICU.

For dextrose based fluids running >3.0 ml/hr, we change the tubing q 72 hrs and 'pull through' the new bag of fluid daily in the meantime. For dextrose based running less than 3.0/hr, we change the tubing q24.

We change lipid and drip tubing q 24.

There was a rumor we would start doing complete line changes daily with all fluids but this has not been implemented yet.

We do sterile line changes with all of our central lines, clean technique with PIV's. Our catheter related infection rate has plummeted with this method.

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

TPN and IL tubing is changed Q24 in our unit, as well as any stopcocks or connectors that the TPN/IL may be running through. Any med tubing is changed Q24hour/PRN as well. Clear IVF tubing changed Q72 per CDC recommendations.

When I hand my fluids for central lines (UAC/UVC/PICC) I always wear sterile gloves to spike the bag, connect the filter and lipid tubing using the glove package as my sterile field. I then open a new package of sterile gloves, take one side of the package and place it in the bed under where I will take the old tubing off and connect the new, put my sterile gloves on and change lines.

For PIVs I use clean technique to change tubing.

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Specializes in Level III NICU.
We don't hang them at the bedside because aesthetics are more important to my managers than anything else.

Oh man, they'd probably DIE if they saw me changing fluids. If I have anything more than 1 bag to change, I wind up with a big ol' mess of spaghetti. I get it all done and I straighten everything out, but it's comical to watch me change fluids, according to my coworkers.

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72 hr. line changes. TPN, IL, drips bag/syringe changes q24. No continuous fluids run through a cap. Intermittent drug tubing is not left up - flush off after each dose given and prime a new med tubing each time.

Policy says central line changes can be done clean with a sterile connection to patient, but most do it all sterile with a sterile field. PIV lines clean.

Who cares if parents see it done at the bedside? A watchful eye of a parent keeps you more clean/sterile whichever because you know they watch your every move! Transparancy has always been a plus in my eyes.

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Specializes in NICU.

We change at the bedside. Clean technique, plus mask. TPN/clear IVF tubing Q72. IL/insulin/aminosyn tubing Q24.

RN's don't change anything other than the tubing on any central line. Any other changes - especially claves and hubs....are done by providers via sterile technique. RN's change everything on PIV's.

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Specializes in NICU, Telephone Triage.

We change TPN and IL Q24.along with tubing. We use sterile technique with a sterile drape and gloves. We "scrub the hub" with alcohol for 15 seconds and let dry for 30 sec. before connecting the new tubing. We change it at the bedside and I always try to do it without visitors there so I won't get disturbed with a million comments or questions.

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Specializes in NICU, Telephone Triage.
We change at the bedside. Clean technique, plus mask. TPN/clear IVF tubing Q72. IL/insulin/aminosyn tubing Q24.

RN's don't change anything other than the tubing on any central line. Any other changes - especially claves and hubs....are done by providers via sterile technique. RN's change everything on PIV's.

What do you mean by providers?

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Oh man, they'd probably DIE if they saw me changing fluids. If I have anything more than 1 bag to change, I wind up with a big ol' mess of spaghetti. I get it all done and I straighten everything out, but it's comical to watch me change fluids, according to my coworkers.

I'm with you, Kate. I try to avoid fluid changes in front of parents at all costs, as I'm sure it undermines what little confidence they had in me to start. I worked a rare day shift the other day and had a student with me. She was trying to be good about it, but I could feel her wanting to ask, "Holy moley... what is going on?"

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