CDC guidelines state that PN tubing can be changed no more frequently
than at 72 hour intervals. Lipid tubing should be changed at 24
hours. If you have lipid piggybacked into PN or PN piggybacked into
lipids, I think that would render it all as a 24 hour tubing. The
issue is microbial growth in lipid products. So when a PN tubing has
contact with lipids, I would want to change it all every 24 hours.
Regarding the INS standards and intermittent tubing, there are
absolutely no studies that have ever been done, that we could find,
on intermittent tubing change intervals. Because of this lack of
data, the INS standards have always stated (2006 edition also) that
these tubings should be changed every 24 hours. This is based on the
fact that both ends of the tubing is being manipulated with each dose
and the general principles of infection control. I have never worked
in any hospital where we extended the life of an intermittent tubing
beyond 24 hours, with or without a filter. Lynn
At 8:19 AM -0800 2/2/06, Jennifer Kettle wrote:
I have a few questions for the group in which I would so appreciate
your input. We are currently looking at policy & procedure at our
institution and want to know what everyone else is doing out there
in the world.
My first question is regarding TPN administration sets. Is anyone
using TPN administration sets longer than 24 hours if using
extended-life filters? (i.e. if filter is specified as bacterial/
fungal retentive for 96 hours?) Also, when setting up for infusion
how do you do so? There is a debate here. Usually, the TPN is set up
first with the filter and the lipids are "piggy backed" into the TPN
set-up below the filter and proximal to the patient. A debate has
arisen as to if this is correct. It is felt by some that the TPN
should be piggy backed into the lipids so that when the q 24 hour
tubing change of the lipids is done all tubing that had lipids
infusing through it would be changed. Theoretically, if the lipids
are piggy backed into the TPN as described above then there would be
a small amount of tubing that had lipids infusing through it that
wouldn't be changed at that time. This is assuming that our theory
is correct with TPN admin set changes and the filter being good for
96 hours.
My next question is regarding tubing changes of primary sets when a
patient's PIV is INT'd. INS standards suggest that this tubing
should be changed every 24 hours. Not sure what the newly released
standards suggest. Or, is anyone extending the life of this
"primary" tubing for 72-96 hours if the 96 hour filter is in place?
Again, thank you for any input that you may have and have a wonderful day.
Jenny Kettle, Rn, BSN
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
