Delivering intravenous (IV) fluids and medications requires administration sets, or IV tubing, which provide a sterile pathway into the bloodstream. Protocols for replacing this tubing are essential to minimize contamination risks and prevent serious bloodstream infections. This article focuses specifically on the duration of use for secondary IV tubing, a component with a distinct function and a strict replacement schedule.
The Role of Secondary IV Tubing
Secondary IV tubing, often called an intermittent or “piggyback” set, serves a specialized purpose within the infusion system. Its primary role is to administer medications, such as antibiotics, or supplemental fluids in small volumes over a short period. This tubing connects to a port, typically a Y-site, on the primary IV line, allowing the intermittent medication to flow into the vein without interrupting the main, continuous infusion.
The secondary set is connected, used, and then disconnected for intermittent dosing, which occurs every few hours rather than continuously. This separate component allows for short-term drug administration without disrupting the main, long-term fluid delivery system.
Standard Replacement Intervals
The generally accepted standard for the duration of secondary IV tubing use is 24 hours. The Infusion Nurses Society (INS) recommends that intermittent administration sets should be changed every 24 hours. This strict time limit is necessary because the tubing is frequently accessed, connected, and disconnected throughout the day for each dose of medication.
This repeated connection and disconnection significantly increases the risk of introducing external bacteria into the sterile fluid pathway. Even if the tubing is only used intermittently, it must be replaced daily to reduce the chance of microbial growth. While primary continuous administration sets can sometimes be used for up to 96 hours, this extended duration does not apply to secondary sets used for intermittent infusions.
Factors Determining Extended or Shortened Use
While 24 hours is the standard for intermittent secondary tubing, certain fluid types mandate a significantly more frequent replacement schedule to prevent contamination or product degradation. Administration sets used for blood products, such as packed red blood cells or plasma, must be replaced after every four hours of use or after two units of blood, whichever comes first. This rapid change is due to the high risk of bacterial proliferation within blood components once they are warmed and infused.
Infusions containing lipids are highly conducive to microbial growth and also require a shortened duration of use. Administration sets used for Total Parenteral Nutrition (TPN) that contains lipids, or for separate lipid emulsions, must be replaced within 24 hours of initiating the infusion. For separate intravenous fat emulsions, some guidelines recommend changing the set every 12 hours. Medications like Propofol, which is suspended in a lipid emulsion, also require a dedicated line that is changed every six or 12 hours, depending on the manufacturer’s directions.
Essential Infection Control Practices
Maintaining the safety of secondary IV tubing until its scheduled replacement requires strict adherence to infection control protocols.
- Disinfection: Before connecting the secondary set, the primary line’s access port must be disinfected using a friction-based technique, commonly called “scrub the hub.” This involves scrubbing the surface with an appropriate antiseptic, such as 70% alcohol, and allowing it to completely air-dry.
- Labeling: The secondary set must be clearly marked with the date, time, and initials of the person who initiated the tubing to ensure the 24-hour replacement schedule is followed accurately.
- Aseptic Technique: Healthcare providers must employ aseptic technique throughout the process of connecting and disconnecting the set to minimize the risk of introducing pathogens.
- Inspection: Any visible signs of damage, leakage at the connection site, or suspected contamination necessitates an immediate, unscheduled replacement of the entire administration set.