A question has recently come up and I would like to get some additional input. I was sent a link that referenced the CDC MMWR (http://www.cdc.gov/mmwr/
In the INS standards of 2016 under standard 42 section IV letter A and B it states to change administration sets for PN solutions every 24 hours. Standard 34 Needleless connectors, states clearly when to change, but it does not say every 24 hours for PN solutions. It does however, state that studies prove that increased frequency of changing caps increases chances for infection.
Finally to my question…. How do you interpret these standards? If this is true that we have to change our PICC ports with our administration sets every 24 hours for PN solutions, then for intermittent administration of say IV ABX, we change our tubing and solutions every 24 hours as per INS standard 42 section III, would we also have to change the PICC port caps? Input please.
Thank you,
Dominic
First, note the very first practice criteria in the needleless connector INS standard. If the PN you are asking about is a continuous infusion, I would totally eliminate the needleless connector. For any continuous infusion, use of a needleless connector is questionable at best. No evidence for or against and we do have one study showing they slow down the infusion rate for some fluids. If the NC is gone, connect the set directly to the catheter hub and luer lock together. This is the way it was done prior to the mania about needlleless connectors on every single catheter lumen, regardless of what they are used for. NC is an infection risk so why add it when it serves no purpose in a continuous infusion? The presence of the NC does not eliminate opening the lumen ( and the associated risk of air entering the line) because the NC should be changed at the same interval as the set change.
If your faciity does not agree with that, then your committees will have to make a decision about when to change the NC in the PN line - every 24 hours or every 96 hrs. No evidence to guide this decision.
For intermittent infusion, the intermittent set is changed every 24 hours, as it is frquently connected and disconnected from the NC with each dose. The change of the NC is not dependent upon when the set is changed in this situation, so the NC can be changed every 96 hours.
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