IV fluid & drug administratioj sets – Burettes or Mini Bags. Open vs Closed Systems

[Anonymous]

Hi All,
We are currently reviewing all of our IV administration lines on contract.
According to the IV Fluid Company Rep – Burettes are not used in the UK or USA
Burettes are still widely used by staff however the evidence based practice literature I have been able to find recommends using closed systems (mini bags) to reduce risk of bacteraemia.
I would greatly appreciate any feedback from facilities that currently use closed systems, especially any facilities that may have converted over to closed systems in the last 1 to 2 years.
I also would greatly appreciate any feedback about how you implemented this change, the challenges associated with this change (if any) and if you noticed any reduction of infection rates.
Many Thanks

Cath Wade

Clinical Nurse Consultant | Infection Prevention and Control
Level 1, 67 Holden Street Gosford Hospital
Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
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[Aileen Moerig (Hawkesbury)]

Hi Cath, I too am interested in removing the burettes and using the closed system for IV administration. Would you be kind enough to post the literature that you have reviewed many thanks Aileen

Aileen Moerig | #Infection Control Coordinator
Hawkesbury District Health Service
T: (02) 4560 5487 | M: | F: (02) 4560 5662 | E: Aileen.Moerig@sjog.org.au
2 Day Street, Windsor NSW 2756 | Locked Bag 10, Windsor NSW 2756
http://sjog.org.au/hawkesbury | http://twitter.com/sjog_healthcare | LinkedIn | http://facebook.com/sjoghealthcare

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We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.

Hi All,
We are currently reviewing all of our IV administration lines on contract.
According to the IV Fluid Company Rep – Burettes are not used in the UK or USA
Burettes are still widely used by staff however the evidence based practice literature I have been able to find recommends using closed systems (mini bags) to reduce risk of bacteraemia.
I would greatly appreciate any feedback from facilities that currently use closed systems, especially any facilities that may have converted over to closed systems in the last 1 to 2 years.
I also would greatly appreciate any feedback about how you implemented this change, the challenges associated with this change (if any) and if you noticed any reduction of infection rates.
Many Thanks

Cath Wade

Clinical Nurse Consultant | Infection Prevention and Control
Level 1, 67 Holden Street Gosford Hospital
Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
[cid:image001.jpg@01D1EE32.5A877FA0][cid:image002.jpg@01D1EE32.5A877FA0]

This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.

Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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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[Tim Spencer]

Hi Cath,
Sorry for the delay in replying to your email – I was work traveling.

The current INS Standards of Practice (2016), with which a lot of infusion therapy-based policies currently reference, considers a burette as an add-on device and the requirements for these are listed in the extracted text below;

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 manipula- tion 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 compro- mised 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 postop- erative infection because of microorganism growth in stopcock dead spaces. Bacterial con- tamination of the patients skin, the providers hands, and the environment contribute to infec- tion 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)

REFERENCES

1. Hadaway L. Infusion therapy equipment. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R. eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:391-436.

2. Alexander M, Gorski L, Corrigan A, Bullock M, Dickenson A, Earhart A. Technical and clinical application. In: Alexander M, Corrigan A, Gorski L, Phillips L, eds. Core Curriculum for Infusion Nursing. 4th ed. Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins; 2014:1-85.

3. Gonzalez Lopez J, Arriba Vilela A, Fernandez del Palacio E, Olivares Corral J, Benedicto Marti C, Herrera Portal P. Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study. J Hosp Infect. 2014;86(2):117-126.

4. Tamura N, Abe S, Hagimoto K, et al. Unfavorable peripheral intravenous catheter replacements can be reduced using an integrated closed intravenous catheter system. J Vasc Access. 2014;15(4):257-263.

5. US Food and Drug Administration. Preventing tubing and luer misconnections. http://www.fda.gov/MedicalDevices/Safety/ AlertsandNotices/TubingandLuerMisconnections/default.htm.

6. US Food and Drug Administration. Safety considerations to mitigate the risks of misconnections with small-bore connectors intended for enteral applications. http://www.fda.gov/downloads/ MedicalDevices/DeviceRegulationandGuidance/Guidance Documents/UCM313385.pdf. Published February 11, 2015.

7. Institute for Safe Medication Practices (ISMP). Stay connected program. http://ismp.org/tools/stayconnectedprogram.aspx.

8. American Nurses Association [position paper]. Safety issues related to tubing and catheter misconnections. http://www.nurs- ingworld.org/position/practice/tube.aspx.

9. 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.

10. Cole D, Baslanti T, Gravenstein NL, Gravenstein N. Leaving more than your fingerprint on the intravenous line: a prospective study on propofol anesthesia and implications of stopcock contamination. Anesth Analg. 2015;120(4):816-867.

11. Loftus R, Brown J, Koff M, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236-1248.

12. Mermel L. Intraoperative stopcock and manifold colonization of newly inserted peripheral intravenous catheters. Infect Control Hosp Epidemiol. 2014;35(9):1187-1189.

13. Sandora TJ, Graham DA, Conway M, Dodson B, Potter-Bynoe G, Margossian SP. Impact of needleless connector change frequency on central line-associated bloodstream infection rate. Am J Infect Control. 2014;42(5):485-489.

I also checked the CDC Guidelines (2011) and there is only 1 reference to burettes in the guideline and its from 1987.
Replacement of Administration Sets

In patients not receiving blood, blood products or fat emulsions, replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, [177] but at least every 7 days [178181]. Category IA

No recommendation can be made regarding the frequency for replacing intermittently used administration sets. Unresolved issue

No recommendation can be made regarding the frequency for replacing needles to access implantable ports. Unresolved issue

Replace tubing used to administer blood, blood products, or fat emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion [182185]. Category IB

Replace tubing used to administer propofol infusions every 6 or 12 hours, when the vial is changed, per the manufacturers recommendation (FDA website Medwatch) *186+. Category IA

No recommendation can be made regarding the length of time a needle used to access implanted ports can remain in place. Unresolved issue

REFERENCE (the only one cited!)

179.Snydman DR, Donnelly-Reidy M, Perry LK, Martin WJ. Intravenous tubing containing burettes can be safely changed at 72 hour intervals. Infect Control 1987; 8:1136.

Also, I did a quick literature search for any newer articles that included burette(s);

Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients – a study protocol for a randomised controlled trial (The RSVP Trial)
Rickard, CM ; Marsh, Nm ; Webster, J ; Gavin, NC ; Mcgrail, Mr ; Larsen, E ; Corley, A ; Long, D ; Gowardman, Jr ; Murgo, M ; Fraser, Jf ; Chan, Rj ; Wallis, MC ; Young, J ; Mcmillan, D ; Zhang, L ; Abu Choudhury, M ; Graves, N ; Playford, Eg
Bmj Open, 2015, Vol.5(2)

Should we use closed or open infusion containers for prevention of bloodstream infections?
Rangel-Frausto, Manuel S ; Higuera-Ramirez, Francisco ; Martinez-Soto, Jose ; Rosenthal, Victor D
Annals of clinical microbiology and antimicrobials, 2010, Vol.9, pp.6

Bacterial colonization and endotoxin contamination of intravenous infusion fluids
Trautmann, M ; Zauser, B ; Wiedeck, H ; Buttenschn, K ; Marre, R
The Journal of hospital infection, November 1997, Vol.37(3), pp.225-36

Variance study of burette aliquot volumes
Schwartz, Lowell M.
The Analyst, 1990, Vol.115(12), pp.1581-1587

Intravenous Tubing Containing Burettes Can Be Safely Changed at 72 Hour Intervals
Gilmore E.
Nutrition in Clinical Practice, February 1988, Vol.3(1), p.33

Changing intravenous tubing containing burettes
Josephson, A
JAMA, 4 January 1985, Vol.253(1), pp.42

Intravenous tubing with burettes can be safely changed at 48 hour intervals
Gorbea, H.F. ; Snydman, D.R. ; Delaney, A. ; Stockman, J. ; Martin, W.J.
Journal of the American Medical Association, 1984, Vol.251(16), pp.2112-2115

Any publications further back are way too old (1946).
I hope this provides some help for you.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)

> On Aug 3, 2016, at 5:25 PM, Aileen Moerig (Hawkesbury) wrote:
>
> Hi Cath, I too am interested in removing the burettes and using the closed system for IV administration. Would you be kind enough to post the literature that you have reviewed many thanks Aileen
>
>
> Aileen Moerig | #Infection Control Coordinator
> Hawkesbury District Health Service
> T: (02) 4560 5487 | M: | F: (02) 4560 5662 | E: Aileen.Moerig@sjog.org.au
> 2 Day Street, Windsor NSW 2756 | Locked Bag 10, Windsor NSW 2756
> http://sjog.org.au/hawkesbury | http://twitter.com/sjog_healthcare | LinkedIn | http://facebook.com/sjoghealthcare
>
>
>
> We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
> We pay our respect to them and their cultures and to Elders past and present.
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Catherine Wade
> Sent: Thursday, 4 August 2016 9:27 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: IV fluid & drug administratioj sets – Burettes or Mini Bags. Open vs Closed Systems
>
> Hi All,
> We are currently reviewing all of our IV administration lines on contract.
> According to the IV Fluid Company Rep Burettes are not used in the UK or USA
> Burettes are still widely used by staff however the evidence based practice literature I have been able to find recommends using closed systems (mini bags) to reduce risk of bacteraemia.
> I would greatly appreciate any feedback from facilities that currently use closed systems, especially any facilities that may have converted over to closed systems in the last 1 to 2 years.
> I also would greatly appreciate any feedback about how you implemented this change, the challenges associated with this change (if any) and if you noticed any reduction of infection rates.
> Many Thanks
>
> Cath Wade
>
> Clinical Nurse Consultant | Infection Prevention and Control
> Level 1, 67 Holden Street Gosford Hospital
> Tel: (02) 4320 2664 | Internal Ext: 92664| Fax: (02) 4320 2874 | Internal Fax: 92874| Page: 18885
> Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
>
>
>
> This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
>
> Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
> 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) tolistserv@aicalist.org.au
>
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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.
>
> 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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