You are absolutely right that nurses are looking for guidance. What can/should INS do to improve and meet this need?
First, as Tim emphatically pointed out, do NOT attempt to proclaim a standard without adequate scientific support. The organization can, however, develop a set of recommendations or even guidelines, acknowledging the limitation of the document in terms of supporting evidence. This is perfectly acceptable and done by other organizations to address these types of situations. Mislabeling statements without any scientific evidence as a "standard" is not helpful to anyone and can even lead to misunderstanding and confusion. Second, determine and then consistently apply a reasonable definition of what constitutes "expert opinion." Third, re-direct association resources allocated to the current "standards" model. Channel a portion of those funds 1) to support development of targeted recommendations and/or guideline documents and a portion to 2) sponsoring new research in those practice issues that need such investigation AND that have been identified by the association as a research priority. Done over time, this would go a long way to improving the knowledge base and generate authoritative documents that are well grounded in science. Well, I have other practical suggestions and could go on, but this is enough for now . . . you get the idea. Meanwhile INS needs to decide if it is willing to consider a new approach. Willingness to change is the first step. I realize that for any organization, this is a difficult and complex. But it is necessary - and increasingly urgent. Marilyn Hanchett RN -----Original Message----- From: Dianne Sim [mailto:[EMAIL PROTECTED] Sent: Tuesday, May 16, 2006 2:00 PM To: 'Lynn Hadaway' Cc: Marilyn Hanchett; [EMAIL PROTECTED] Subject: RE: outpt infusion reusing IV tubing 72hr I happen to agree with you on this one Lynn. The masses are looking for guidance on all IV issues and the INS seems to be the logical place for them to go. Until investments are made in both money and time to provide us with studies to establish evidence-based practice, we have to have position statements provided by our professional organizations , based on a combination of "logic" and the opinion of nurses experienced in the subject. Take a deep breath Marilyn Dianne Sim RN CEO & President IV Assist, Inc., 2675 Appian Way Pinole, CA 94564 Phone: (510) 222-8403 Fax: (510) 222-8277 Email: [EMAIL PROTECTED] Confidentiality Notice: This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway Sent: Tuesday, May 16, 2006 8:48 AM To: Marilyn Hanchett; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: outpt infusion reusing IV tubing 72hr Then my question to you is - In the absence of evidence, what do we use to guide our practice? Is this just supposed to be a vacuum while we wait for the science to catch up? I totally understand the need for evidence, but you know as well as I do that many, many nursing and medical standards and guidelines are written on nothing less than the professional opinions of experts. I am not saying that is ideal, but I am saying that until we have evidence, this is the best that we can do. I am very curious to know what your approach would be to any situation when there are no studies, yet professional organizations are expected to provide some guidance on these issues. Lynn At 11:26 AM -0400 5/16/06, Marilyn Hanchett wrote: >So - once again - we have a "national standard" without any evidence >whatsoever to support it. This process, including the "logic" behind >it, is an embarrassment to all of us who advocate for evidence-based >practice. > >Even if you feel compelled to defend the current (or previous) >standards documents, this is just too much. Good grief! > >Marilyn Hanchett RN > > >-----Original Message----- >From: [EMAIL PROTECTED] >[mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway >Sent: Tuesday, May 16, 2006 9:54 AM >To: [EMAIL PROTECTED]; [EMAIL PROTECTED] >Subject: Re: outpt infusion reusing IV tubing 72hr > >This practice would be in direct conflict with the INS standards of >practice. This set would be an intermittent set, therefore it should be >changed every 24 hours according to the INS standards of practice. >CDC guidelines states this is an unresolved issue. There are absolutely >no studies that have looked at the use, change interval or anything >regarding sets used for intermittent infusion. This is the reason for >the INS standard of changing every 24 hours. You are manipulating both >ends of the set frequently. Based on principles of basic infection >control and in the absence of any studies, it seems wise to follow the >standards. One the other hand, your facility could do a study of this >practice and publish your findings which would benefit everyone. Also, >the INS standards apply to all settings. >While primary and secondary sets should be changed no more frequently >than 72 hours, INS separates the intermittent sets and this would apply >to both inpatient and outpatient settings. > >One other thought is that you would need to have a foolproof method to >make sure that the right set gets hooked back to the right patient each >day. I can imagine lots of cross-contamination between patients if they >were to get mixed up. With busy, understaffed units, I can easily see >this happening. Lynn > >At 7:50 PM -0400 5/15/06, [EMAIL PROTECTED] wrote: >>To reduce cost a suggestion was made to reuse the IV tubing for >>72hours > >>on a patient that comes in for daily infusion. The patient would have >>a > >>PICC and come for maybe daily abx's. The infusion is done the tubing >>flushed with NS, disconnected from the PICC and a sterile cap placed >>on > >>the IV tubing. It is stored in the med room and used by the same pt >>for > >>3 infusions. >>We have been discarding the tubing daily and replacing with new IV >>tubing daily. >> >>Any support for or against this suggested practice. P&P is for tubing >>change 72 hrs but that was written for inpt >> >>Thanks >> >>Pat Dobson > > >-- >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 -- 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
