Replacement frequency for central line administration sets

[Michael Wishart]

Hi all

We are reviewing our central line policies and have two different standards for administration set (line) changes: one for oncology haematology, and one for every else, including ICU. Haem/onc routinely change administration sets for all central devices (CVC’s and PICC’s) every three days (dressings and needleless access devices changed every 7 days), whilst everyone else routinely changes everything (administration sets, needleless access devices, dressings) every 7 days.

Is anyone aware of any specific data supporting more frequent line changes for haem/onc patients? Is it standard practice in other places to change all administration sets for central devices every 7 days?

Thanks for any discussion (and specifically supporting evidence) on this.

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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[Marija Juraja]

Hi Michael,

I have these guidelines from the UK with the literature evidence on page 23 which may help re the infusion sets.

Kind Regards

Marija Juraja |Clinical Service Coordinator (CICP) – Infection Prevention & Control Unit|
t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |e:marija.juraja@health.sa.gov.au

Care Excellence Collaboration Integrity
GERMS CAN KILL…

Hi all

We are reviewing our central line policies and have two different standards for administration set (line) changes: one for oncology haematology, and one for every else, including ICU. Haem/onc routinely change administration sets for all central devices (CVC’s and PICC’s) every three days (dressings and needleless access devices changed every 7 days), whilst everyone else routinely changes everything (administration sets, needleless access devices, dressings) every 7 days.

Is anyone aware of any specific data supporting more frequent line changes for haem/onc patients? Is it standard practice in other places to change all administration sets for central devices every 7 days?

Thanks for any discussion (and specifically supporting evidence) on this.

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

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WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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[Claire Rickard]

Hello Michael

Amanda Ullman recently (2013) updated the Cochrane Review on this topic.
Extending AS use from 72 to 96 days appears safe (including for non-lipid
PN), but there are inadequate studies looking at longer periods to draw
strong conclusions. The exception to this is lipid administration to
neonates where less frequent replacement in one study was linked to
increased infections. Apart from that, all comparisons whether 24 vs 48
hour, or 48 vs 72, 72 vs 96 etc have never found any sign of increased
infection by changing sets less frequently (just reduced costs).

The CDC (2011) now advocate replacement “between 4 and 7 days” for all
lines, based on the Cochrane Review. I agree there is higher uptake in ICUs
of 7 day replacement in ICUs, this is in part due to an Australian ICU RCT
which found 4 and 7 days equivalent for infection, although some guidelines
say only to go to 7 days if you are using antimicrobial lines since that
was what was studied.

We are currently recruiting for a large NHMRC funded, multi-site RCT
comparing 4 vs 7 days, and if anyone would like to get involved please let
me know. We need 5,000 more tunneled and non-tunneled CVADs please!!

As far as haem/onc specific trials, there is one RCT of 512 patients which
compared 3 day with “between 4 and 7 day” use and found no significant
difference in infusate-related BSI. A quasi-randomised trial in 175
paediatric oncology patients found extending AS use from 3 to 7 days had no
significant impact on IVD-BSI, and achieved substantial cost savings in AS
and nursing time.
– Raad, I., et al. Optimal frequency of changing intravenous administration
sets: is it safe to prolong use beyond 72 hours? *Infection Control and
Hospital Epidemiology, *2001, 22(3):136-139.
– Simon, A., et al. Influence of prolonged use of intravenous
administration sets in paediatric cancer patients on CVAD-related
bloodstream infection rates and hospital resources. *Infection, *2006,
34(5):258-263.

Hope this is helpful and happy to discuss further if you like.

Claire

Best regards, Claire

*Professor Claire Rickard RN PhD*
*Assistant: Jo Wright *Jo.Wright@griffith.edu.au +61 (0)7 3735 4886 (ext
54886)

c.rickard@griffith.edu.au | +61 (0)7 3735 6460 | Skype:
clairexm1 | Twitter: AVATAR_Grp |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Australian Vascular Access Teaching and Research Group | NHMRC Centre of
Research Excellence in Nursing Interventions | Griffith Health Institute
Centre for Health Practice Innovation | Royal Brisbane & Women’s
Hospital | Princess Alexandra Hospital | The Prince Charles Hospital

Research frequently takes me off campus. Please contact
Jo.Wright@griffith.edu.au 3735 4886, or School Secretary (Nathan) Jenny
Chan 3735 5406 *j.chan@griffith.edu.au* for urgent
enquiries.

“By changing nothing, we hang on to what we understand, even if it is the
bars of our own jail” *John LeCarre*

On 20 February 2014 16:41, Juraja, Marija (Health) wrote:

> Hi Michael,
>
>
>
> I have these guidelines from the UK with the literature evidence on page
> 23 which may help re the infusion sets.
>
>
>
> *Kind Regards*
>
>
>
> *Marija Juraja* *|Clinical Service Coordinator (CICP) – Infection
> Prevention & Control Unit| *
>
> t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |
> e:marija.juraja@health.sa.gov.au
>
>
>
> *Care* *Excellence* *Collaboration* *Integrity *
>
> GERMS CAN KILL…
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Thursday, 20 February 2014 4:29 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* [ACIPC_Infexion_Connexion] Replacement frequency for central
> line administration sets
>
>
>
> Hi all
>
>
>
> We are reviewing our central line policies and have two different
> standards for administration set (line) changes: one for oncology
> haematology, and one for every else, including ICU. Haem/onc routinely
> change administration sets for all central devices (CVC’s and PICC’s) every
> three days (dressings and needleless access devices changed every 7 days),
> whilst everyone else routinely changes everything (administration sets,
> needleless access devices, dressings) every 7 days.
>
>
>
> Is anyone aware of any specific data supporting more frequent line changes
> for haem/onc patients? Is it standard practice in other places to change
> all administration sets for central devices every 7 days?
>
>
>
> Thanks for any discussion (and specifically supporting evidence) on this.
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart*
>
> *Infection Control Coordinator*
>
> *Holy Spirit Northside Private Hospital*
>
> 627 Rode Road, Chermside, Qld 4032
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226
>
> *e:* Michael.Wishart@hsn.org.au
>
> *w:*www.holyspiritnorthside.org.au
>
> Please consider the environment before printing this email
>
>
>
>
>
>
>
>
> WARNING : This email contains information, which is CONFIDENTIAL, and that
> maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it
> (the “Communication”) is confidential and is for the use only of the
> intended recipient, and may not duplicated or used by any other party
> without the express consent of the sender. The Communication may contain
> copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of
> its related entities or of third parties. If you are not the intended
> recipient of the Communication, please notify the sender immediately by
> return e-mail, delete the Communication, and do not read, copy, print,
> retransmit, store or act in reliance on the Communication. Any views
> expressed in the Communication are those of the individual sender only,
> unless expressly stated to be those of SVHAC. SVHAC does not guarantee the
> integrity of the Communication, or that it is free from errors, viruses or
> interference. Thank-you.
> ——————————
>
> Message protected by MailGuard: e-mail anti-virus, anti-spam and content
> filtering.
> http://www.mailguard.com.au
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> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
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> or services by brand or commercial names, please do this outside the list.
>
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>
> Replies to this message will be directed back to the list. To create a new
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[Klintworth, Gemma]

Hi Michael,
We reviewed our CVAD guideline early last year and have recommended the
following timeframes for administration line changes:
Parenteral nutrition – 24/24
Antimicrobial impregnated CVCs – 7 days (these are the predominant lines
in ICU)
All other CVADs (non AB impregnated) – 96 hours
This has largely been based on the 2011 CDC guidelines and also some of
the references given by Claire.
These timeframes are meant to be for continuous infusions as we try to
discourage reconnection of lines. This is our recommendation
organisation-wide, including for our haem patients.
Hope this helps.
Gemma
Gemma Klintworth
Infection Prevention Nurse Consultant
Infection Prevention and Healthcare Epidemiology

t 03 90762250 e G.Klintworth@alfred.org.au

m 0419 383 840

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia

Alfred Health incorporates The Alfred, Caulfield Hospital and
Sandringham Hospital
http://www.alfredhealth.org.au

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Behalf Of Michael Wishart

Hi all

We are reviewing our central line policies and have two different
standards for administration set (line) changes: one for oncology
haematology, and one for every else, including ICU. Haem/onc routinely
change administration sets for all central devices (CVC’s and PICC’s)
every three days (dressings and needleless access devices changed every
7 days), whilst everyone else routinely changes everything
(administration sets, needleless access devices, dressings) every 7
days.

Is anyone aware of any specific data supporting more frequent line
changes for haem/onc patients? Is it standard practice in other places
to change all administration sets for central devices every 7 days?

Thanks for any discussion (and specifically supporting evidence) on
this.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3607 2226

e: Michael.Wishart@hsn.org.au

w:www.holyspiritnorthside.org.au

Please consider the environment before printing this email

WARNING : This email contains information, which is CONFIDENTIAL, and
that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments
to it (the “Communication”) is confidential and is for the use only of
the intended recipient, and may not duplicated or used by any other
party without the express consent of the sender. The Communication may
contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”),
or any of its related entities or of third parties. If you are not the
intended recipient of the Communication, please notify the sender
immediately by return e-mail, delete the Communication, and do not read,
copy, print, retransmit, store or act in reliance on the Communication.
Any views expressed in the Communication are those of the individual
sender only, unless expressly stated to be those of SVHAC. SVHAC does
not guarantee the integrity of the Communication, or that it is free
from errors, viruses or interference. Thank-you.

________________________________

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