I am inquiriing about the practices others are delivering regarding IV solution hang time ( not talking about the tubing) which includes maintenance fluids as well as pre mixed medication bags such as dopamine, heparin as well as insulin that was mixed under a hood etc. Currently our policy indicates medications to be changed every 24 hours. Therefore ALL solutions, premixed medications as well as any other medication is being removed after 24 hours as indicated by the INS. A question was raised in regards to the reasoning behind this practice. Medications that are administered as a secondary infusion (i.e. antibiotics) is understandable that the seondary as well as the primary should be changed every 24 hours. There are other medications such as dopaime, heparin, insulin (mixed under a hood) etc. that are really primary infusions. Should these medications be replaced with a new bag every 24 hours.? I would think changing the medication bag every 24 hours would be compromising a closed system. The 2016 INS Standard of Practice addressess the primary and secondary administration set time frames, but I am assuming we are talking only about the tubing is that correct? or does it apply to the medications/solutions as well?
If anyone could she some light on this matter would be great. Finding evidence based guidelines on this matter would be greatly appreciated.
Thank you,
Sandi Kishi RN, BSN, CRNI, VA-BC
Kaiser Permanente Hawaii - ATC
Sad to say that you will not find ANY real evidence to answer your question. This issue was one of the major components of a presentation I gave at the annual APIC conference last June, Infection Prevention in IV Therapy - The Unanswered Questions.
The recommendation for changing all fluid containers came about in the 1970's from CDC as a result of a nationwide outbreak of IV infections. This was traced to the rubber closure on the IV bottles at that time, long before plastic bags were available. Also sad to say that I was a practicing IV nurse at that time!! LOL.
Since then, there have not been any other studies on this issue except for 1 descriptive study from Australia but that study said more study was necessary. During the severe shortage of IV fluids a couple of years ago, the ASHP guidelines stated to consider extending the infusion time for fluid containers without additives but this was only driven by the fact that bags of normal saline were in very short supply.
CDC removed any statement about hang time for the fluid container from the HICPAC guidelines many years ago. So no studies means no standards or guidelines of any kind. Your hospital must make a decision about what they want to do about this issue but my impression is that most facilities have continued with the 24 hour policy. Eager to see what others say about this. 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
It has always been my understanding that our IV solution bags contained NO PRESERVATIVES and that bacteria could proliferate after that 24 hr period. Now I believe that it is different if the med was compounded under a laminar flow hood in the pharmacy. When they mix up a bag, i.e. a morphine cassette to be attached to a CADD pump, then that stabilty is longer and perhaps up to one week.
What say you?
IV fluid containers do NOT contain a preservative. The problem with this is when people want to enter the bag multiple times for obtaining flush solution and this practice is well documented to cause contamination and outbreaks of BSI. The container is intended to be spiked once and that is all. Additionally, the 24 hr limit came about more than 35 years ago and the problem was corrected. So these facts beg the question of can the fluid container be allowed to hang longer than 24 hours. We do have a single study on that issue showing that allowing longer hang time did not increase risk of BSI. This study was not adequate alone to write a new standard for CDC, INS, or any other organization. Using a bag for multiple entries is definitely prohibited, but we do not know if a container could be allowed to hang for longer than 24 hr with regard to the infection risk. Use of the laminar airflow hood has not led to any changes in hang time. Use of a morphine infusion on a CADD pump is not comparing apples to apples. Those systems are closed usually with no injection sites and the set is usually permanently attached to the container. 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
Thank you for your responses, I really appreaciate it. We are primarily addressing pre mix medications from the mnufacturers as well as those medications mixed under the hood. These medications would not have any other medications piggybacked and are primarily a closed system. So my other question is, since we are currently changing the medication bag every 24 hours should'nt we be changing the entire administration set? I guess I feel if I don't change the whole system than it kind of defeats the purpose of changing the medication bag. Is everyone out there changing the entire system on these medications or just the medication bags? Thank you, would greatly appreciate input on this matter.
Thanks
Sandi Kishi, RN, BSN, CRNI, VA-BC