From: Kokotis, Kathy [mailto:[EMAIL PROTECTED]
Sent: Tuesday, May 16, 2006 9:38 PM
To: Marilyn Hanchett; Dianne Sim; Lynn Hadaway
Cc: [EMAIL PROTECTED]
Subject: RE: outpt infusion reusing IV tubing 72hr
From: [EMAIL PROTECTED] on behalf of Marilyn Hanchett
Sent: Tue 5/16/2006 2:25 PM
To: Dianne Sim; Lynn Hadaway
Cc: [EMAIL PROTECTED]
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]
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
