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Hi all,
Does anyone have any evidence or best practice guidelines for the above
please?
Where I am currently working, this happens all the time, both with PIVCs
and CVADs (rather worrisome).
Sometimes these giving sets are hanging around, disconnected for several
hours. And theres the risk of them being forgotten.
But the biggest problem is the staff capping the end and thinking this is
ok. Im not seeing good hand hygiene for a start but surely theres a risk
of contamination once the giving set is disconnected from the the cannula?
And does anyone have anything around how long IV fluids can sit in the
giving set for once disconnected?
I have found a guideline from 2009 from the Royal Hospital for Women, but
its not quite specific enough.Thanks in advance,
Helen Scott, ICP.MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Helen
We have this statement in our IV infusion care policy:
Intermittent disconnection of administration sets used for continuous infusions, is not recommended due to the increased risk of infection through manipulation of the hub and occlusion due to reflux of blood into the cannula tip when the line is disconnected; Intermittent administration sets should be discarded after each use if disconnected
This is based on the QLD iCARE guidelines (https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf ).
Hope this helps.
Cheers
MichaelMichael Wishart, CICP-E
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Helen Scott
Sent: Wednesday, 21 February 2018 11:31 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Discouraging disconnection of IV fluids for showering patients ad going to X-ray etc.Hi all,
Does anyone have any evidence or best practice guidelines for the above please?
Where I am currently working, this happens all the time, both with PIVCs and CVADs (rather worrisome).
Sometimes these giving sets are hanging around, disconnected for several hours. And theres the risk of them being forgotten.
But the biggest problem is the staff capping the end and thinking this is ok. Im not seeing good hand hygiene for a start but surely theres a risk of contamination once the giving set is disconnected from the the cannula? And does anyone have anything around how long IV fluids can sit in the giving set for once disconnected?
I have found a guideline from 2009 from the Royal Hospital for Women, but its not quite specific enough.Thanks in advance,
Helen Scott, ICP.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi there,
The Infusion Nurses Society Standards 2016 state this which may be helpful
but not very specific:
‘Avoid disconnecting primary continuous administration sets from the VAD
hub or access site. (V, Committee Consensus)’ (page S84)
and
III. Primary Intermittent Infusions
A. Change intermittent administration sets every 24 hours. When an
intermittent infusion is repeatedly disconnected and reconnected for the
infusion, there is increased risk of contamination at the spike end,
catheter hub, needleless connector, and the male luer end of the
administration set, potentially increasing risk for catheter-related
bloodstream infection (CR-BSI). There is an absence of studies addressing
administration set changes for intermittent infusions. 10 (V, Committee
Consensus)
B. Aseptically attach a new, sterile, compatible covering device to the
male luer end of the administration set after each intermittent use. Do not
attach the exposed male luer end of the administration set to a port on the
same set (looping). 3,12 (V)Ruth Barratt
Infection Prevention & Control AdvisorOn Thu, Feb 22, 2018 at 9:33 AM, Mary Wyer wrote:
> I can’t offer any existing guidelines – but here are a few other things to
> consider if you are developing one.
>
> – Staff I see often disconnect an IV and “cap” it onto the side port –
> usually with no alcohol swabbing of the side port.
> – Patients also often request to have IVs disconnected (for showers
> and walks) and don’t understand why the nurse yesterday did and you won’t.
> We need to talk with patients & visitors a lot more about why this is not
> good for them.
>
>
>
> *Mary Wyer*
>
> *ORCID ID*: orcid.org/0000-0002-1215-8089
> *Alumni Foundation Brocher:* http://www.brocher.ch/en
> *Twitter: *@mary_wyer
>
>
>
> On Wed, Feb 21, 2018 at 12:41 PM, Michael Wishart Michael.Wishart@svha.org.au> wrote:
>
>> Hi Helen
>>
>>
>>
>> We have this statement in our IV infusion care policy:
>>
>>
>>
>> Intermittent disconnection of administration sets used for continuous
>> infusions, is not recommended due to the increased risk of infection
>> through manipulation of the hub and occlusion due to reflux of blood into
>> the cannula tip when the line is disconnected; Intermittent administration
>> sets should be discarded after each use if disconnected
>>
>>
>>
>> This is based on the QLD iCARE guidelines (https://www.health.qld.gov.au
>> /__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf ).
>>
>>
>>
>> Hope this helps.
>>
>>
>>
>> Cheers
>>
>> Michael
>>
>>
>>
>>
>>
>> *Michael Wishart, *CICP-E
>>
>> Infection Control Coordinator
>>
>>
>> *A *627 Rode Road, Chermside QLD 4032
>>
>> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
>> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
>> [image: cid:image001.png@01D01926.61F1C2B0]
>>
>> P *Please consider the environment before printing this email *
>>
>>
>>
>>
>>
>> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
>> Behalf Of *Helen Scott
>> *Sent:* Wednesday, 21 February 2018 11:31 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* [ACIPC_Infexion_Connexion] Discouraging disconnection of IV
>> fluids for showering patients ad going to X-ray etc.
>>
>>
>>
>> Hi all,
>>
>>
>>
>> Does anyone have any evidence or best practice guidelines for the above
>> please?
>>
>> Where I am currently working, this happens all the time, both with PIVCs
>> and CVADs (rather worrisome).
>>
>> Sometimes these giving sets are hanging around, disconnected for several
>> hours. And theres the risk of them being forgotten.
>>
>> But the biggest problem is the staff capping the end and thinking this is
>> ok. Im not seeing good hand hygiene for a start but surely theres a risk
>> of contamination once the giving set is disconnected from the the cannula?
>> And does anyone have anything around how long IV fluids can sit in the
>> giving set for once disconnected?
>>
>> I have found a guideline from 2009 from the Royal Hospital for Women, but
>> its not quite specific enough.
>>
>>
>>
>> Thanks in advance,
>>
>> Helen Scott, ICP.
>>
>> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
>> NOT REPRESENT THE OPINION OF ACIPC.
>>
>> The use of trade/product/commercial brand names through the list is
>> discouraged by ACIPC. If you wish to discuss specific reference to products
>> or services by brand or commercial names, please do this outside the list.
>>
>> Archive of all messages are available at http://aicalist.org.au/archives
>>
>> – registration and login required.
>>
>> Replies to this message will be directed back to the list. To create a
>> new message send an email to aicalist@aicalist.org.au
>>
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>> aicalist-request@aicalist.org.au.
>>
>> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
>> the quotes) to listserv@aicalist.org.au
>> ______________________________________________________________________
>> This email and any attachments to it (the “Email”) is confidential and is
>> for the use only of the intended recipient, and may not be duplicated or
>> used by any other party without the express consent of the sender. If you
>> are not the intended recipient of the Email, please notify the sender
>> immediately by return email, delete the Email, and do not copy, print,
>> retransmit, store or act in reliance on the Email. St Vincent’s Health
>> Australia (“SVHA”) does not guarantee that the Email is free from errors,
>> viruses or interference. Emails to and from SVHA or its related entities
>> may be scanned and filtered in locations outside Australia.
>>
>>
>> ______________________________________________________________________
>> This email and any attachments to it (the “Email”) is confidential and is
>> for the use only of the intended recipient, and may not be duplicated or
>> used by any other party without the express consent of the sender. If you
>> are not the intended recipient of the Email, please notify the sender
>> immediately by return email, delete the Email, and do not copy, print,
>> retransmit, store or act in reliance on the Email. St Vincent’s Health
>> Australia (“SVHA”) does not guarantee that the Email is free from errors,
>> viruses or interference. Emails to and from SVHA or its related entities
>> may be scanned and filtered in locations outside Australia.
>> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
>> NOT REPRESENT THE OPINION OF ACIPC.
>>
>> The use of trade/product/commercial brand names through the list is
>> discouraged by ACIPC. If you wish to discuss specific reference to products
>> or services by brand or commercial names, please do this outside the list.
>>
>> Archive of all messages are available at http://aicalist.org.au/archives
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>> aicalist-request@aicalist.org.au.
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>> the quotes) to listserv@aicalist.org.au
>>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives
> – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new
> message send an email to aicalist@aicalist.org.au
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Helen and all,
I would also have a look at the 2016 INS Standards of Practice, which is the go-too document for infusion therapy and vascular access professionals.
Here is the excerpt on Add-On devices.36. ADD-ON DEVICES Standard
36.1 Add-on devices are used only when clinically indicated for a specific purpose and in accordance with manufacturers directions for use.
36.2 Add-on devices are of luer-lock or integrated design to ensure a secure junction, reduce manipulation, and minimize the risk of disconnection.Practice Criteria
Consider the use of add-on devices (eg, single- and multilumen extension sets, manifold sets, extension loops, solid cannula caps, needleless connectors, in-line filters, manual flow-control devices and stop- cocks) only for clinical indications. When indicated, preferentially use systems that minimize manipulation and reduce multiple components, such as inte- grated extension sets (see Standard 34, Needleless Connectors).1-4 (IV)
Clinical indications may include adding length, enabling filtration capabilities, or enhancing function of the infusion system (ie, adding an extension to decrease movement/manipulation at the short peripheral catheter hub).1,2 (V)
Consider that the potential for contamination exists with all add-on devices. Limit the use of add-on devices whenever possible to decrease the number of manipulation episodes, acciden- tal disconnections or misconnections, and costs.1-9 (IV)
Ensure that all add-on devices are compatible with the administration system to prevent the risk of leaks, disconnections, or misconnections.5-6 (V)
Change the add-on device with new vascular access device (VAD) insertion, with each administration set replacement, or as defined by the organization, and whenever the integrity of the product is compromised or suspected of being compromised.1,2 (V)
Avoid the use of stopcocks due to the increased risk of infection.
Propofol anesthesia may increase risk for postoperative infection because of microorganism growth in stopcock dead spaces. Bacterial con- tamination of the patients skin, the providers hands, and the environment contribute to infection risk associated with stopcocks.10,11 (IV)
Use a stopcock or manifold with an integrated needleless connection rather than a solid cap or replace the stopcock with a needleless connector to reduce stopcock contamination.12,13 (IV)
42. ADMINISTRATION SET CHANGE
Standard
42.1 Administration set changes are performed routinely, based on factors such as type of solution administered, frequency of the infusion (continuous versus intermittent), immediately upon suspected contamination, or when the integrity of the product or system has been compromised.
42.2 In addition to routine changes, the administration set is changed whenever the peripheral catheter site is changed or when a new central vascular access device (CVAD) is placed.
42.3 A vented administration set is used for solutions supplied in glass or semirigid containers, and a non-vented administration set is used for plastic solution containers.
42.4 Administration sets are attached to a vascular access device (VAD) hub or access site with a luer- locking mechanism to ensure a secure junction.
Practice Criteria
I. General
A. Minimize the use of add-on devices for administration sets as each device is a potential source of contamination, misuse, and disconnection; when feasible use an administration set with devices as an integral part of the set (refer to Standard 36, Add-on Devices).
B. Check the packaging of administration sets for latex and avoid use of a latex-containing set for patients with a latex allergy (refer to Standard 14, Latex Sensitivity or Allergy).
C. Attach the administration set and prime just prior to administration.1,2 (V, Regulatory)
D. Label administration sets for infusion via VADs with the date of initiation or date of change based on organizational policies and procedures. Label administration sets used for medications that are administered via specialized access devices (ie, intraspinal, intraosseous, subcutaneous) to indicate the correct administration route and device, and place the label near the connection to the device.3,4 (V)
E. Trace all catheters/administration sets/add-on devic- es between the patient and the solution container before connecting or reconnecting any infusion/device, at each care transition to a new setting or service, and as part of the handoff process.5-7 (IV)
II. Primary and Secondary Continuous Infusions
Replace primary and secondary continuous adminis- tration sets used to administer solutions other than lipid, blood, or blood products no more frequently than every 96 hours. There is strong evidence that changing the administration sets more frequently does not decrease the risk of infection.8-11 (I)
Change a secondary administration set that is detached from the primary administration set every 24 hours as it is now a primary intermittent administration set (see Practice Criteria III, Primary Intermittent Infusions).3 (V)
Avoid disconnecting primary continuous administration sets from the VAD hub or access site. (V, Committee Consensus)
III. Primary Intermittent Infusions
Change intermittent administration sets every 24 hours. When an intermittent infusion is repeatedly disconnected and reconnected for the infusion, there is increased risk of contamination at the spike end, catheter hub, needleless connector, and the male luer end of the administration set, potentially increasing risk for catheter-related bloodstream infection (CR-BSI). There is an absence of studies addressing administration set changes for intermittent infusions.10 (V, Committee Consensus)
Aseptically attach a new, sterile, compatible cover- ing device to the male luer end of the administration set after each intermittent use. Do not attach the exposed male luer end of the administration set to a port on the same set (looping).3,12 (V)
Now this is not exhaustive but my provide some clarity.
You may also find some of these references have something potentially useful;
Simmons D, Symes L, Guenter P, Graves K. Tubing misconnections: normalization of deviance. Nutr Clin Pract. 2011;26(3):286-293.Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011;52(2):211-212.
Ayer P, Adams S, Boullata J, et al. A.S.P.E.N. parenteral nutrition safety consensus recommendations. J Parenter Enteral Nutr. 2014;38(3):291-333.
DeVries M, Mancos PS, Valentine MJ. Reducing bloodstream infection risk in central and peripheral intravenous lines: initial data on passive intravenous connector disinfection. J Assoc Vasc Access. 2014;19(2):87-93.
Marschall J, Mermel LA, Fakih M, et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-asso- ciated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7): 753-771.
Flynn, J. M., Keogh, S. J., & Gavin, N. C. (2015). Sterile v aseptic non-touch technique for needle-less connector care on central venous access devices in a bone marrow transplant population: A comparative study. European Journal of Oncology Nursing, 19(6), 694-700.
Nancy L. Moureau and Julie Flynn, Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review, Nursing Research and Practice, vol. 2015, Article ID 796762, 20 pages, 2015
Hope this is helpful.
Regards,
Tim..Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 409 463 428 (AU)
http://www.vascularaccess.com.au
http://orcid.org/0000-0002-3128-2034> On Feb 21, 2018, at 4:37 PM, Lindy Ryan wrote:
>
> Hello Helen
>
> Like Michael NSW have some guidelines that may help as well as they indicate similar to what QLDs documents
>
> NSW PIVC GL2013_013 document (which I believe are under review but these do remain current at this time)may hopefully also provide you with some direction in section 9.3 Care of admin sets pg 7
>
> 9.3 Care of administration sets
> 9.3.1 Label all administration sets attached to the PIVC with an intravenous line label in accordance with NSW Policy User applied labelling of Injectable Medicines, Fluids and Lines 13
>
> 9.3.2 IV tubing sets should not be disconnected for routine care, but may be disconnected for transient, controlled disconnections such as changing IV infusions, removing a sling or sleeve, or access in Operating Theatres, Medical Imaging or Radiology Departments
>
>
> 9.3.3 Except for transient controlled disconnections as above, if the IV giving set is disconnected, replace the entire IV tubing
>
>
>
> Kind regards
>
>
> Lindy Ryan
>
> District Infection Prevention & Control CNC | Clinical Governance Unit MNCLHD
> Level 1 Coffs Specialist Centre, Pacific Hwy, Coffs Harbour
> Mob 0419 990 693 | lindy.ryan@ncahs.health.nsw.gov.au
> http://www.health.nsw.gov.au
>
>
>
> Wise and humane management of the patient is the best safeguard against infection
> (Florence Nightingale Circa 1860)
>
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
> Sent: Wednesday, 21 February 2018 12:41 PM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Discouraging disconnection of IV fluids for showering patients ad going to X-ray etc.
>
> Hi Helen
>
> We have this statement in our IV infusion care policy:
>
> Intermittent disconnection of administration sets used for continuous infusions, is not recommended due to the increased risk of infection through manipulation of the hub and occlusion due to reflux of blood into the cannula tip when the line is disconnected; Intermittent administration sets should be discarded after each use if disconnected
>
> This is based on the QLD iCARE guidelines (https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf ).
>
> Hope this helps.
>
> Cheers
> Michael
>
>
> Michael Wishart, CICP-E
> Infection Control Coordinator
>
> A 627 Rode Road, Chermside QLD 4032
> P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
>
> P Please consider the environment before printing this email
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU ] On Behalf Of Helen Scott
> Sent: Wednesday, 21 February 2018 11:31 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Discouraging disconnection of IV fluids for showering patients ad going to X-ray etc.
>
> Hi all,
>
> Does anyone have any evidence or best practice guidelines for the above please?
> Where I am currently working, this happens all the time, both with PIVCs and CVADs (rather worrisome).
> Sometimes these giving sets are hanging around, disconnected for several hours. And theres the risk of them being forgotten.
> But the biggest problem is the staff capping the end and thinking this is ok. Im not seeing good hand hygiene for a start but surely theres a risk of contamination once the giving set is disconnected from the the cannula? And does anyone have anything around how long IV fluids can sit in the giving set for once disconnected?
> I have found a guideline from 2009 from the Royal Hospital for Women, but its not quite specific enough.
>
> Thanks in advance,
> Helen Scott, ICP.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new message send an email toaicalist@aicalist.org.au
> To send a message to the list administrator send an email to aicalist-request@aicalist.org.au .
>
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> ______________________________________________________________________
> This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
>
>
> ______________________________________________________________________
> This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
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> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
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