Policy on IV tubing/bag change?

[climberrn]

I'm in a new unit and their policy on changing iv tubing/bags is different from where I worked. I looked up CDC guidelines (actually googled it and got sent to another site but it seems legit) and the recommendations seem little contradictory. Here's the site for anyone who is feeling motivated!

4.5: Prevention of IV Related Infections

The basics are nothing new: change tubing q 72 hours, maintain a closed system, etc.

Then it says that Large Volume Parenterals should be used up or discontinued if not completed in 24 hours.

Large volume is not defined...is that the 4L bag of TPN (obviously) or the 50cc bag of epinephrine? What about the 250cc bag of epi?

My issue (and maybe it's just me...my previous institution changed everything: bags, tubings, stopcocks, q 72 hours except for TPN) is that if you change the bag q 24 but change the tubing q 72 aren't you breaking that closed system? If your base solution isn't dextrose, it seems that by unspiking, then respiking a new bag, you have a greater risk for introducing infection than if you kept it closed.

Any thoughts? Any other websites I can check?

[jill48, ASN, RN]

Fluids/medication of anysort that remain are changed q24h. TPN tubing q24. All other tubing q 96.

96 hours seems too long. I've never heard of that before. I have always changed bags q 24 hrs and lines q 72hrs. Alot of the times I would just change the tubing along with the bag; I think that is the safest whether it is policy or not.

[Marie_LPN, RN, LPN, RN]

We still use the ruler-looking strips.

[augigi, CNS]

I was quite anal retentive in my ICU days - we had sticky labels with each commonly used drug name, or blank ones we could fill in (all different colours). I labelled every bag, line (at the top and at the patient) as well as labelling the pump chambers. One of the first things I did every shift.

[General E. Speaking, RN, RN]

not to hi-jack the thread but I was wondering what y'all do about mult. IVPBs and the tubing. I was taught to back flush with the main IVF and keep one secondary tubing system in place. I guess I really need to check with our actual policy, but I frequently see numerous secondary tubing hanging on poles. Is this taught in school nowadays? I was taught there would be a greater chance of infection by switching the tubing back and forth, therefore, keeping the system as closed as possible was best.

[GatorRN]

i was quite anal retentive in my icu days - we had sticky labels with each commonly used drug name, or blank ones we could fill in (all different colours). i labelled every bag, line (at the top and at the patient) as well as labelling the pump chambers. one of the first things i did every shift.

glad to know i'm not the only one who has done this..lol. i felt lost until i got all my lines and pump chambers labeled accordingly. we didn't have the pre-made labels though, i wrote them all up, all different colors, of course.

to the original question: all bags changed q 24h. all tubing changed q 72h. with the exception of tpn/ppn, lipids and diprivan which was changed q 24hours.

_________________________________________________

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:w00t: national championship bowl bound!! :w00t:

[Elvish, BSN, DNP, RN, NP]

We change IVF bags q24hrs but rarely have to worry about bags staying up longer than that, as most of our fluids are going in at 100/hr or more and everything has to be on a pump.

Tubing gets changed q72hr as do IV sites. The only (rare) exception is if there is someone who is a REALLY hard stick, the site is fine, and the pt is not complaining of tenderness/burning etc. Then we have to get the docs to write an order to leave IV site as until it goes bad or whatever. Like I said, that is very rare. But we also very rarely give vesicants and I am anal about checking my site anyway before and during if we do. Sorry for the digression.

[miko014]

not to hi-jack the thread but I was wondering what y'all do about mult. IVPBs and the tubing. I was taught to back flush with the main IVF and keep one secondary tubing system in place. I guess I really need to check with our actual policy, but I frequently see numerous secondary tubing hanging on poles. Is this taught in school nowadays? I was taught there would be a greater chance of infection by switching the tubing back and forth, therefore, keeping the system as closed as possible was best.

Depends if the IVPBs are compatible with each other or not. If they are, we use the same tubing. If not, we get another out. If It is compatible, I spike the bag and back prime also.

For us, nothing (tf included) is to hang greater than 24 hours. Site/tubing changes every 72 hours. Someone said something about tubing every 24 hours and that reusing the same tubing for 3 days allows a greater risk for infection. But I can't think of many pts with a drip rate slow enough for a bag to last them 24 horus, so if that theory is correct, then wouldn't you need new tubing every time you changed the bag? I think as long as you are just unspiking one bag and popping it straight into the next one, it's fine. Just maintain the sterility of the spike. You know, like, don't lick it or anything.

[wooh, BSN, RN]

You know, like, don't lick it or anything.

Ok, do you have evidence to back that up? I'd like to see the literature on that!!

[augigi, CNS]

Lucky coincidence - I am trying to cut down on licking hospital equipment this month! :)

[Christie RN2006]

Where I work, TPN bags and tubings have to be changed every 24 hours. IV lines going into a peripheral port have to be changed every 3 days, but lines going into a central line/A-line have to be changed every 2 days. IV bags have to be changed every 24 hours.

[RazorbackRN, BSN, RN]

TPN/Lipids Q24

Albumin Q shift

Insulin Q24

Vitamin C Q24

All others Q72

[justpoorfect]

This is interesting. At a clinical site, my pt. had NS 20ml/hr KVO from a 1000 ml bag for 50 hrs. When I checked the tubing, it was tagged to be changed 9 DAYS EARLIER!!