Well put Marilyn. I agree with the statement that nurses want and
need guidance. We must get to the point where a recommendation is
enough. This word standard causes many problems. Infusion
therapy needs to develop science to support the actions we take. Just look
at infiltration. The INS standard was for years heat. Then the
science was done and the real answer was probably nothing or cold. I
believe that there are many things we do in practice that the science would
surprise us. Years ago heparin in peripheral lines was found to not impact
occlusion rates. Nursing in all disciplines is in need of science.
We are in a terrific position to see this as an opportunity for
growth. Even recommendations can cause problems because they are developed
from the past. As many of you know, the future comes fast and
furiously. If we do not move forward and try new things many opportunities
are missed. As nurses we need to stay involved in our specialty, read and
stay up on new things, ask questions and use our critical thinking skills.
The bottom line is important but not the only issue.
Denise Macklin
----- Original Message -----
Sent: Tuesday, May 16, 2006 4:25 PM
Subject: RE: outpt infusion reusing IV
tubing 72hr
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]
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-----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
|
