Hello;
Is anyone familiar with the practice of not needing to change an extension set as long as it was attached to the central catheter at the time of insertion and not inserted afterwards? My team is revising policies and this is identified as the current practice, that "if the extension set was attached to the central line at the time of insertion, replace the extension set only if leaking or damaged". The INS standards are pretty clear in stating that "add-on devices used as part of the administration set, such as single and multi-lumen extension sets and filters, shall be changed at the same time as the administration set".
The situation that has brought this to question was a scenario where a home health client wants to manage their own TPN and can only do so if an extension set is added-on (otherwise they cannot reach the connection). If we add an extension set that needs to be changed every 24 hrs (as is required with IVFE) then the nurse still needs to visit every day. If the extension set did not require changing if added at time of insertion then the client can remain independant. I cannot find any resources to support the practice of not changing the extension set but many resources to support changing it daily. Is this a practice that is being followed?
Thanks
The INS SOP 26 Practice Criteria F also states the change of add-on devices should be "--or as defined by the organization---".
In an old issue of the CDC Guidelines, there was a small footnote mentioning that an extension set attached to a PICC could be considered as part of the catheter and left in place when it was added during the insertion procedure and the junction was maintained under the sterile dressing. That footnote has long been removed.
For parenteral nutrition, the issue is the IVFE and the recommendation that all sets exposed to it be changed at least every 24 hours due to risk of infection. This is an issue with inpatients when the IVFE is piggybacked to the PN. The entire PN set is changed every 96 hours, along with the extension set. See SOP 43 Parenteral Nutrition.
There is no good answer for your question. I would work with my infection preventionist to make the best policy for your agency. 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 so much Lynn for your quick response. It was more helpful than you may know!
Tammy
Tammy Rooke, RN BscN CCHN(c)
Clinical Practice Manager
Red Cross Care Partners