labeling peripheral IV lines

EricJRN, MSN, RN · Nov 17, 2011

I don't know of a tubing labeling study for solid evidence-based practice, but there is plenty of practice-based evidence that says we aren't careful enough with IV tubing.

The Institute for Safe Medication Practices (www.ismp.org) is a great resource for info about medication safety. Some of the stories out there can give you nightmares though: caustic IV meds connected to gavage tubes, NIBP tubing connected to an IV port, and enteral feeds given intravenously - just to name a few.

More than preventing infection, labeling gives you that one last chance to make sure that the right drug is connected to the right line belonging to the right patient. It also helps everybody else to know what's going on after you walk away.

On my unit, our patients get most meds by syringe pump. In the rush to get ready for shift report, occasionally a med is connected but inadvetently not started. This may not be caught until the offgoing nurse has left. If there's a label on the med and the tubing, it's easy to fix. If there's a syringe of clear mystery med connected to a spaghetti mess of tubing (which may be either the patient's peripheral or central line), the oncoming nurse is walking into a hazardous situation right away.

tarheelsu · Nov 18, 2011

When you label the tubing, you mark either the date you put it up or the date it is due to be changed. From what I know, the guidelines are based on the risk of infection based on how many times the IV tubing system (from the IV site through the tubing to the IV bag) is opened. Every time it's opened there is an increased risk for contamination and therefore infection. So piggybacks where the tubing is connected and disconnected more frequently needs to be changed more frequently whereas primary bags changed less.

If you are labeling the tubing with the medication being run then that could help make sure the all the piggybacks are compatible with each other and the primary fluid. I think of it as one more check to make sure medication errors aren't made.

IVRUS, BSN, RN · Nov 18, 2011

Here is the thing. I'm in nursing school and had a little discussion with my instructor. I know that she is right, but I went to do clinicals at a hospital and told her that they change the IV lines for every new medication. She said that we have to label even the meds that run for 30 minutes as a piggy-back, for example. I want to see where they have as an evidence-base practice to label the IV lines for every single thing. I know labeling is better to prevent infections and such, but I wanna see where they have it. I have googled it but haven't found much about it. Does anyone know a creditable good website? Please?

So, are you saying that if a patient does NOT have a mainline, like a liter bag hanging, and all they have ordered is an antibiotic, like Ancef 1 gm IV q 8 hours, that they use new IV tubing every eight hours? Whew, what a waste. INS (Infusion Nurses Society) states that IV tubing in this case would be good for 24 hours, or three doses. However, if the tubing is NOT labeled, and there is no sterile end cap placed on the IV tubings end after disconnection from the Injection cap of the patient's IV, then it should be pitched and one should start over with new tubing. It's wasteful to practice this way though.

ParkerBC,MSN,RN, PhD, RN · Nov 18, 2011

So, are you saying that if a patient does NOT have a mainline, like a liter bag hanging, and all they have ordered is an antibiotic, like Ancef 1 gm IV q 8 hours, that they use new IV tubing every eight hours? Whew, what a waste. INS (Infusion Nurses Society) states that IV tubing in this case would be good for 24 hours, or three doses. However, if the tubing is NOT labeled, and there is no sterile end cap placed on the IV tubings end after disconnection from the Injection cap of the patient's IV, then it should be pitched and one should start over with new tubing. It's wasteful to practice this way though.

My thoughts exactly.

Labeling the tubing is a good idea with the date and the name of medication. You will see, especially working critical care that patients have all kinds of tubing. It helps to quickly identify which medication is running in which tube rather than starting at the top and sorting out the tangled mess. This in turn will save you a lot of headaches and time. Another advantage is for IV push medications. There are some medications that aren't compatible with others. With that being said, the last thing you would want to do is push an IV med in the line of an incompatible drug. I don't know if there is evidence-based practice regarding this practice. I think it is another means of being organized and preventing errors.

classicdame, MSN, EdD · Nov 18, 2011

does not really matter what anyone else says - while in school you jump thru the loops and label each one. We do not label the tubing as it is changed every M-W-F and the smart pumps have a digital screen indicating what is being infused.

thatchergirl, BSN, RN · Nov 20, 2011

thanks you guys for the feedback. At my school we have clin sims (clinical simulation) and we act like the nurse and do the interventions for that specific patient (dummie). What happened was that I had clinicals the weekend before and at the hospital I had clinicals at they don't label the tubing. The patient had an IV running and had abx to be hung as well. I got into a discussion with my teacher because the nurses at the hospital would say: "oh the line went dry... I'll just put a new one in" every time we had to change the line. I got points off for my simulation because I labeled the tube with the NS but not the one for the abx. She was all ****** saying that I should know that and all and I explained what they do at this particular hospital and we started discussing it. Long story short, I wanted to see where they have evidence base practice about it. We don't label (at least on the clinical simulations) the tube to know what the medication is. We label it with the date we started the line or when we are supposed to discontinue it.

turnforthenurse, MSN, NP · Nov 21, 2011

Again, nursing school and real-world nursing = different. At my hospital, we change IV tubing Q3 days. We have different colored stickers with different days of the week that say "change _____" on them that are supposed to be attached the tubing (I say supposed to because not all of my coworkers do this, making it hard to determine when the tubing was initially used -_-). You should also put the date.

As for labeling regarding medications, I will do this if a patient has multiple things running at the same time. This is common in critical care units where sometimes patients will have 6+ things infusing at the same time! I just take a piece of tape and put it on the IV tubing half-way down and write what is infusing. As another check to prevent med errors, I will still "trace the tubing" back to the pump and back to the bag to make sure that is the line I want to use. I will also label actual IV pumps with tape if I have multiple things running. For drips (heparin, insulin, any kind of vasoactive drug, Cardizem, Amiodorone, Integrillin, etc) we can set a dose mode on the pumps and also set the drug that is infusing, so the pump itself will have the drug name, too.