question around IV fluids – seeking advice

[Ryan, Lindy]

Hello

I have been asked the following question from an operating theatre NUM

‘How long do you recommend IV fluids be kept once they have been attached to a giving set and the line primed. Both for IVs and arterial lines?”

They are telling me the lines are being set up for use but not connected to any pt & just being set up as part of resuscitation / or urgent need & then left untouched in case of another emergency to prevent wastage & time in reality …some staff discard straight away and others think they can be kept for a few hours …so they just want to establish a time frame potentially around infection risk if not used how long they can keep them for???…does anyone have any evidence based information I could guide them with …I could say if not used straight away discard (common-sense)….but wondered if anyone had anything with more substance given this may not be useful feedback for them to just follow if I have no idea and the information I have found is a bit unclear ….

I checked the following

1. CDC Guidelines for the prevention of IVCRI’s 2011 but it had no recommendations

2.Our national 2010 NHMRC ACSQHC IC guidelines (pg 144) recommend that they may be left for intervals of up to 4 days (if not containing lipids) however I am under the impression that this is a line that is currently in use & connected to a patient and not waiting to be used???

3.2010 RCN Infusion standards recommends
2.6 Expiry dates
The maximum expiry date for any injection/ infusion prepared in a clinical area is 24 hours or less in accordance with the manufacturer’s specification of product characteristics (NPSA, 2007b).

appreciate any other leads or advice to provide staff

many thanks in advance

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

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“Wise and human management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

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[Michael Wishart]

Hi Lindy

I don’t have any definitive evidence or guidelines here (although will possibly be something in the INS guidelines, but I don’t have them available to me currently), but we have had this discussion a few times here. One of the big non-no’s for me is leaving unconnected primed lines hanging (even with a bung on the end) in an unmonitored area, where anyone could potentially handle it.

The ‘mother test’ gets applied here: would I let this be used on my mother, not knowing if someone had handled and contaminated this setup?

So, the only places we have (tacitly, not formally) agreed can do this are very time limited anyway (cath lab, theatre) mainly for lists, as we discourage the practice but if they can guarantee it cannot be contaminated by inappropriate handling an are always under observation, we sort of turn a blind eye to it.

Hopefully someone has something more definitive for you than the ‘mother test’. 🙂

Cheers
Michael

Michael Wishart
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
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Hello

I have been asked the following question from an operating theatre NUM

‘How long do you recommend IV fluids be kept once they have been attached to a giving set and the line primed. Both for IVs and arterial lines?”

They are telling me the lines are being set up for use but not connected to any pt & just being set up as part of resuscitation / or urgent need & then left untouched in case of another emergency to prevent wastage & time in reality …some staff discard straight away and others think they can be kept for a few hours …so they just want to establish a time frame potentially around infection risk if not used how long they can keep them for???…does anyone have any evidence based information I could guide them with …I could say if not used straight away discard (common-sense)….but wondered if anyone had anything with more substance given this may not be useful feedback for them to just follow if I have no idea and the information I have found is a bit unclear ….

I checked the following

1. CDC Guidelines for the prevention of IVCRI’s 2011 but it had no recommendations

2.Our national 2010 NHMRC ACSQHC IC guidelines (pg 144) recommend that they may be left for intervals of up to 4 days (if not containing lipids) however I am under the impression that this is a line that is currently in use & connected to a patient and not waiting to be used???

3.2010 RCN Infusion standards recommends
2.6 Expiry dates
The maximum expiry date for any injection/ infusion prepared in a clinical area is 24 hours or less in accordance with the manufacturer’s specification of product characteristics (NPSA, 2007b).

appreciate any other leads or advice to provide staff

many thanks in advance

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and human management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments 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.

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[Tim Spencer]

Hi Lindy,

From a quick review of the INS guidelines, I think if the bag has been
spiked, it must be used within 24hrs (also in line with the current RCN
standards of practice). Page S55 addresses the Primary Intermittent
Infusions, Practice Criteria A & B.

In regards to the ACSQHC guidelines, I believe you are correct in its
reference to being attached to a patient – 96hr maximum dwell time.

IVNNZ Provisional Infusion Therapy Standards of Practice March 2012
guidelines (pp43-44) also make the same recommendations as INS – 25hrs max.

As long as there is a new, sterile cover over the luer connection after the
administration set has been opened to protect the connection, these
pre-prepared administration sets should be ok to be used based around
current reviews.

I agree with you that there is not enough supportive evidence in this
practice and needs further investigation.

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Vascular Access Consultant
Founding President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

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Of Ryan, Lindy

Hello

I have been asked the following question from an operating theatre NUM

‘How long do you recommend IV fluids be kept once they have been attached to
a giving set and the line primed. Both for IVs and arterial lines?”

They are telling me the lines are being set up for use but not connected
to any pt & just being set up as part of resuscitation / or urgent need &
then left untouched in case of another emergency to prevent wastage &
time in reality .some staff discard straight away and others think they can
be kept for a few hours .so they just want to establish a time frame
potentially around infection risk if not used how long they can keep them
for???.does anyone have any evidence based information I could guide them
with .I could say if not used straight away discard (common-sense)..but
wondered if anyone had anything with more substance given this may not be
useful feedback for them to just follow if I have no idea and the
information I have found is a bit unclear ..

I checked the following

1. CDC Guidelines for the prevention of IVCRI’s 2011 but it had no
recommendations

2.Our national 2010 NHMRC ACSQHC IC guidelines (pg 144) recommend that they
may be left for intervals of up to 4 days (if not containing lipids) however
I am under the impression that this is a line that is currently in use &
connected to a patient and not waiting to be used???

3.2010 RCN Infusion standards recommends

2.6 Expiry dates

The maximum expiry date for any injection/ infusion prepared in a clinical
area is 24 hours or less in accordance with the manufacturer’s specification
of product characteristics (NPSA, 2007b).

appreciate any other leads or advice to provide staff

many thanks in advance

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs
Harbour Health Campus

Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au

http://www.health.nsw.gov.au

“Wise and human management of the patient is the best safeguard against
infection”

(Florence Nightingale Circa 1860)

_____

This message is intended for the addressee(s) named and may contain
confidential information. If you are not the intended recipient, please
delete the message and any attachments 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

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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.

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