Changing IV Tubing: Saving Money Without Compromising Care

Jan Almond, RN, BSN, MS Karla Ennis, RN, BSN Susan Maloney, RN, BSN Blair Whitley, RN, BSN University of North Carolina at Charlotte

Background

• Hospital care necessitates IV therapy in most cases.

• Nosocomial bloodstream infections can be directly linked to the use of an intravascular device.

• Reduction in changing IV tubing sets saves the patient and hospital money.

• Reduction in changing IV tubing sets saves the nurse time that he/she could be spending on patient care. • Centers for Disease Control and Prevention. (2011).

Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011

. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

Gillies, Donna, Wallen, Margaret M, Morrison, Anne L, Rankin, Karen, Nagy, Sue A & O'Riordan, Elizabeth. (2008). Optimal timing for intravenous administration set replacement.

Cochrane Database of Systematic Reviews,

(4). doi:10.1002/14651858.CD003588.pub2

Purpose

• To review the evidence base regarding optimal timing for IV tubing replacement when used for peripheral IV therapy • To compare the current policy at Stanly Regional Medical Center (SRMC) to published findings and guidelines • To provide a plan for implementing a policy change at SRMC that is consistent with these findings and guidelines

Search Strategy: Databases

Databases Searched:

CINAHL Plus, Medline, Academic Search Complete, Science Direct, Springer Link, Cochrane

Keywords:

IV/intravenous tubing, infection, change, sets

Exclusions:

• findings that were not relevant to the topic • findings before 2007

Total Findings:

one systematic review, one journal article

Search Strategy: Cited References

Cited references reviewed from:

• CDC’s “Guidelines for the Prevention of Intravascular Catheter Related Infections, 2011” • Database search findings

Exclusions:

Same as for database search

Additional Findings:

two journal articles, one journal supplement

The literature says…

• A meta-data analysis found that replacement at any of 24, 48, 72 or 96 hours did not change infection risk (Cochrane Collaboration, 2005) • Recent studies suggest that administration sets may be used safely for up to 7 days if used in conjunction with antiseptic catheters or if fluids that enhance microbial growth (CDC, 2011)

All primary continuous administration

Stanly

sets and secondary sets shall be

Regional

changed every 72 hours.

Medical

Administration sets utilized for TPN

Center

Says…

shall be changed every 24 hours. All primary intermittent administration sets shall be changed every 24 hours.

Centers for Disease Control

Says…

Replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96 hour intervals, but at least every 7 days.

Discussion

• Research results are minimal and inconclusive regarding a specific time frame for changing IV tubing. • Research shows that frequently replacing IV tubing to prevent infection is expensive and time consuming, with a poor evidence base.

• Hospira, a manufacturer of IV tubing, recommends following the CDC or the healthcare facility policy.

Discussion: Future Directions

• The RSVP trial, conducted by Prof. Clair Rikard, will compare four and seven day IV tubing changes.

• During a three-year study (2011 – 2014), infection and cost benefits of less frequent changes of IV tubing will be evaluated.

Discussion

• SRMC’s policy requires more frequent changes than recommended by the CDC.

• Based on the findings from future research, i.e. the RSVP study, SRMC may be able to extend the length of time for changing IV tubing.

• Following CDC guidelines would save time and money without compromising patient care.

References

Centers for Disease Control and Prevention (2011).

Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011

. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

Change IV tubing less often. (2011).

Australian Nursing Journal, 19(4

), 22.

Eggimann, P. (2007). Prevention of intravascular catheter infection.

Current Opinion in Infectious Diseases

,

20

(4), 360 369. doi: 10.1097/QCO.0b013e32818be72e

Gillies, D., Wallen, M., Morrison, A., Rankin, K., Nagy, S., & O'Riordan, E. (2008). Optimal timing for intravenous administration set replacement.

Cochrane Database of Systematic Reviews,

(4). doi:10.1002/14651858.CD003588.pub2

Hadaway, L. (2007). Intermittent intravenous administration sets: Survey of current practices. 147. doi: 10.2309/java.12-3-10

JAVA

,

12

(3), pp. 143 Infusion Nurses Society (2011). Infusion nursing standards practice.

Journal of Infusion Nursing

, 34(supplement). Lifeshield Primary IV Plumset. Lake Forest, IL: Hospira, Inc.; 2006.

Raad, I., Hanna, H. A., Awad, A., Alrahwan, A., Bivins, C., Khan, A., & ... Mansour, G. (2001). Optimal frequency of changing intravenous administration sets: Is it safe to prolong use beyond 72 hours?

Infection Control and Hospital Epidemiology

,

22

(3), 136-139.

Stanly Regional Medical Center, Nursing Manual. (2011). Intravenous Therapy Policy (Stanly Regional Medical Center Policy ID: SMHPCMANU7700151). Stanly Regional Medical Center: Albemarle, NC.