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question around IV fluids – seeking advice

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  • #72161
    Ryan, Lindy
    Participant

    Author:
    Ryan, Lindy

    Position:

    Organisation:

    State:

    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)

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    #72162
    Michael Wishart
    Participant

    Author:
    Michael Wishart

    Position:

    Organisation:

    State:
    NSW

    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
    [cid:image001.png@01D01926.61F1C2B0]
    P Please consider the environment before printing this email

    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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    #72163
    Tim Spencer
    Participant

    Author:
    Tim Spencer

    Position:

    Organisation:

    State:

    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

    “Be a yardstick of quality. Some people aren’t used to an environment where
    excellence is expected.” – Steve Jobs

    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

    To send a message to the list administrator send an email to
    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.

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