Using one secondary set for all IVPB's

[Robinr1958]

Hello All,

The hospital I work at presently uses separate tubing for each IVPB. I have worked at other facilities that use one for all and feel that this practice probably is not only more cost effective but also decreases the infection risk as the system is broken less frequently. I am looking for some documentation (studies, other information) that supports this as my facility is fairly slow to change without documention that strongly supports the benefits. Please share any documentation you may have to help us out.

Thanks,

Robin

[NRSKarenRN, BSN, RN]

tried a google search---couldn't find much info:

from vanderbuilt university:

re-spiking is strongly discouraged due to the high risk of touch contamination. utilizing a new bag/bottle is always preferable. however, when re-spiking is clinically unavoidable, the bag/bottle may hang no longer than 24 hours from that time or a total of 72 hours, whichever comes first.

http://vumcpolicies.mc.vanderbilt.edu/e-manual/hpolicy.nsf/alldocs/a9f2fa520d39db3d86256923005421a4

did find a great multipage book chapter on medication administration:

medications [color=#6f6f6f]file format: pdf/adobe acrobat

... floor, it must be discarded and a new one administered ... be given im or if agency requires the use of a ... if agency has a needleless iv system, medication is ready ...

connection.lww.com/products/ evans-smith/documents/pdfs/ch05.pdf

[MelissaRN]

I've had patients with really bad staph infections and have had to be on 3 different types of IV antibiotics. I always use separate tubing for each antibiotic because some of them are incompatible. I also flush the primary tubing with the maintenance tubing. Also label the secondary tubing with the date so you know when to replace it and use a red cap on the end.

[Spidey's mom, ADN, BSN, RN]

If someone is on more than one antibiotic and has a mainline IV fluid running, I always use separate secondary sets. If they have a saline lock and have separate antibiotics or even just one, I use primary tubing.

I have always wondered about the reasoning behind opening a closed system to change tubing in a perfectly good IV site just because the tubing has been up for 72 hours. Opening the system up at the hub to change the tubing seems to me to add to the risk of infection.

steph

[Ortho_RN]

I use the same secondary set for the same antibiotic... Tubing is good for 72hrs... Many antibiotics aren't compatible... I know someone tried to use Vancomycin tubing for another antibiotic, and it crystallized in the tubing...

[military girl]

There was a big to-do on my floor about this. I didn't really know how to do it, but the other nurses have been doing it for a while. Now that I know how to do it, it does save time, however, sometimes, I wonder if it would be safer to use separate tubing. This is expensive if you have a patient on multiple antibiotics, since they are charged for each piece of tubing.

I use the same IVPB tubing but always backflush to clear the line when a different drug is hung. I've done this for years without a problem.

[boggle, ASN, RN]

The answer may depend on the brand/type of tubing and pump you use.

The Baxter pump and tubing are made for using ONE piggyback tubing for multiple different piggyback medications.

You are supposed to:

backprime the piggyback tubing and invert the old empty piggyback bag allowing the backpriming solution to flow into it, then disconnect the old bag, then spike the new bag and infuse.

Backpriming in this fashion flushes the piggyback tubing and makes it safe for infusion of the new med. This also minimizes breakes in the system that could open the path for contamination.

Think of it, you don't change the entire IV tubing when you infuse different meds. You just flush it.

[Robinr1958]

Thanks to everyone for your responses. I have used the same tubing for multiple IVPB's in another facility but we always backflushed the mainline fluids to clear the previous med out of the tubing...Never had a problem with incompatibilities as the backflush cleared other meds out. We even used TKO Normal Saline if the patient didn't have routine fluids going (with approval of the MD's. I am hoping to find some official documentation supporting this practice as it seems to me that breaking the system fewer times has to be better...not to mention the cost effectiveness of using fewer tubings.

thanks again,

Robin

[Corrections RN]

Thats fine till you mix the wrong things and the patient suffers. Use different tubing for each ABX/admix. I have seen salt precipitation and I have seen the negative effects on patients.