Speaking of changing lines....

babynurselsa, RN · Dec 14, 2006

Depends on unit policy.

Some places I worked we used a new tubing each time. Others we changed q 24.

LoveTheNICU · Dec 14, 2006

We change ours q72 hours, just like our standard clear fluid tubings. That way, if the kiddo is not on TPN, the entire set can be changed all together every three days, and prevent frequent breaking into the line. The only "clear" solutions/meds and tubings we change more often are high dextrose solutions, insulin, lasix and PGE-1.

Gompers, BSN, RN · Dec 14, 2006

When you hang a piggyback med on a syringe pump, do you change the tubing every time or do you put a flush on and leave the flush on and only change the syringe out? I have been doing some research and it seems that there are places that do this and use the same tubing for 48-72 hours. We are looking for ways to decrease our line sepsis. It sounds like a good idea and I can see the rationale for it as you aren't entering the line closest to the baby all the time. Any thoughts? Thanks!

You mean if a baby is getting, say, Vanco Q24H, you'd give the med and then put a flush on the microbore tubing to keep it clean, then reusing it the next time the med is due?

That do that in our PICU, but we've never done that in NICU. We use fresh microbore tubing every time for every med.

I guess I'm not understanding very well. Is this tubing staying attached to the baby's IV lines the whole time? Wouldn't you run out of ports? Some of our kids are on multiple IV meds and antibiotics, and there are only so many ports on an IV tubing line. Is my brain fuzzy???

BittyBabyGrower, MSN, RN · Dec 15, 2006

You're not fuzzy :roll Yes...that is what I'm saying. You would reuse the same tubing for multiple meds as you have run flush thru it and it is cleaned out. We use stopcocks on lines when we have mulitple infusions instead of a bunch of Y's hanging off...all you have to do is turn the stopcock off and back on when you need it.

dawngloves, BSN, RN · Dec 15, 2006

We have a contraption where there is a a stopcock connected to a bag of NSS and the microbore tubing. You leave the syringe on, turn the stopcock and draw up your flush. Turn the stopcock and give your flush.You cut in half the times you break the line! We change it Q 72.

lovemyjob · Dec 15, 2006

we put a t connector on the end of the med line tubing (I think tahts the microbore) then to the very end we pu a 1/2 NS flush (10cc) and teh we put the meds on the other end of the t connector where there is an injection port. the ns is only changed when it expires or runs out. we are changing our lines q 96. again you only re-enter the line with the med by putting an alligator clip on it and connecting it to the injection port. also, you must always close the rest of the t connector that goes to the flush or else you med will run up in the flush, not to the baby.

i couldnt get the pic to come up, but maybe you can:

https://www.shopmedvet.com/product/3469/69

KRVRN, BSN, RN · Dec 17, 2006

We use the same med tubing for several meds too. Our policy is to leave the med tubing attached to the stopcock and only change it when changing out the whole IV tubing set up. (This is esp important with PICCs) The rationale is that then you are not constantly entering and reentering the sterile system to attach and detach med tubing.

Gompers, BSN, RN · Dec 17, 2006

We use the same med tubing for several meds too. Our policy is to leave the med tubing attached to the stopcock and only change it when changing out the whole IV tubing set up. (This is esp important with PICCs) The rationale is that then you are not constantly entering and reentering the sterile system to attach and detach med tubing.

While I understand the thought process, the fact is that you are still attaching a new syringe to the end of the tubing every time you give a med, so the system is being opened anyways. Now, it would be different if you could, say, draw up an entire syringe of Gent and leave it attached, only infusing the amount needed when the med is due. But of course that's not safe so in the end, the system is being broken into every time you unscrew the current syringe or flush that's on the end of the tubing. True, there is probably less chance of contamination since it's not like you have to swab a rubber port with alcohol or betadine before pushing a needle into it, but it's still a break in the system.

BittyBabyGrower, MSN, RN · Dec 18, 2006

But it kind of like changing the TPN bag and not the tubing, KWIM? We did observations in our unit and noted that many people would forget to wipe the line or not wait for whatever they wiped on their to dry or be on the appropriate amount of time before entering the line. This way, you aren't entering a port that has been laying in the bed and has whatever creepy things on it.

lovemyjob · Dec 18, 2006

We use the same med tubing for several meds too. Our policy is to leave the med tubing attached to the stopcock and only change it when changing out the whole IV tubing set up. (This is esp important with PICCs) The rationale is that then you are not constantly entering and reentering the sterile system to attach and detach med tubing.

But do you remove the flush to infuse the med abd then reattach the flush?

We keep our medline attached as well, just not through a stopcock.

KRVRN, BSN, RN · Dec 18, 2006

But do you remove the flush to infuse the med abd then reattach the flush?
We keep our medline attached as well, just not through a stopcock.

Yes. The tubing stays attached at the stopcock but the syringe at the other end is changed over and over. It doesn't make a lot of sense does it? Plus then we end up leaving a big long med tubing hanging off the IV line, and of course it gets in the way when baby is being held, etc.

And another thing I wonder about, these med tubings are primed with NS that comes form those little SINGLE USE bottles that are preservative free. So if it's a few hours between meds, the NS jsut sits in the tubing until we infuse another med.