Transcript An Evidence-Based Practice Proposal presentation

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)
Stanly
Regional
Medical
Center
Says…
All primary continuous administration
sets and secondary sets shall be
changed every 72 hours.
Administration sets utilized for TPN
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 96hour 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), 360369. 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. JAVA, 12(3), pp. 143147. doi: 10.2309/java.12-3-10
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.