Lynn,
When the INS standard changed regarding the primary and secondary continuous administration sets time frame of use, a hospital changed their policy to 7 days. "Minimal disconnect allowances" are made which clearing does not mean continuously connected at all times.
Have you heard of any hospitals publishing research which has a zero infection rate and keep their continous sets for 7 days?
Finally, the standard states 7 days may be considered if fluids that enhance microbial growth are not administered through the set. Wouldn't you agree that any dextrose solution should not be used then to meet this statement?
thanks
You are confusing the Infusion NUrsing Standards of Practice with the CDC Guidelines for Prevention of Intravascular Catheter-Related Infections. INS document states no more frequently than 96 hours. CDC states no more frequently than 96 hours but at least every 7 days. INS does not include the 7 days statement. I don't know what you mean by "minimal disconnect allowances", never heard that term before, so will need some explanation. Studies on IV sets do not report rates of CRBSI, so I don't think you will find one that reports zero infections. There is one study extending set life to 7 days. According to INS if you are disconnecting any set for a period of time, it would be an intermittent set and should be changed every 24 hours. This would apply to those situations where a bag of carrier fluid is used with the intermittent meds attached to the set for the carrier fluid. Meds infuse, then fluid flushes line to get all of the dose infused, then the whole system is disconnected until the next dose. This whole system is an intermittent one and should be changed at 24 hours. Sets used in this manner could never be considered for 7 days, but maybe that is not what you are asking me. All fluids carry a certain risk for supporting the growth of certain types of organisms. For PN, the risk is candida. For fluids, mainly gram negs. But nothing grows unless the fluids or set has become comtaminated by some means. Disconnection of continuous fluids and sets along with disconnection of intermittent sets with each dose, regardless of how you configured the set(s) would increase the risk of contamination because you are manipulating the set and catheter hub. So if fluids are continuous, leave it connected until it is time to change the set at 96 hours to 7 days. If infusing only intermittent meds, with or without a plain fluid carrier, change the set every 24 hours. We do not have any studies on intermittent administration sets, therefore th reason for the various statements from INS and CDC. INS says 24 hours because that was the original time frame for all sets. CDC says this is an unresolved issue acknoweldging the fact that intermittent and continuous sets are different and that there are no studies on intermittent sets. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
One other thing - before you change policy to allow 7 days use for continuous sets, check with your set manufacturer on their instructions for use for this length of time. 7 days may be longer than their internal testing. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861