Intravenous (IV) tubing, also known as an administration set, is the plastic apparatus that connects a fluid container or medication bag to a patient’s intravenous access device. Its primary function is to safely regulate the flow of fluids, nutrients, or medications directly into the bloodstream. Health organizations establish standardized protocols for replacing this tubing to reduce the risk of infection and maintain the integrity of the treatment system. Following these schedules is a fundamental aspect of patient care and infection prevention.
The Role of Contamination Control in IV Maintenance
The frequency of changing IV tubing is directly tied to managing the risk of microbial contamination. Over time, the internal surface of the tubing, known as the lumen, can become colonized by microorganisms, leading to the formation of a protective layer called a biofilm. This biofilm can slough off, releasing bacteria or fungi into the bloodstream, which contributes to catheter-related bloodstream infections (CRBSIs). Guidelines for set replacement are designed to minimize the microbial load before it reaches a dangerous concentration. Different types of fluids and infusion methods create varying levels of risk, which dictates the replacement schedule.
Standard Guidelines for Continuous Infusions
For the continuous infusion of non-blood and non-lipid solutions (like saline, dextrose, or standard medications), the administration set can be used for an extended period. Organizations like the Infusion Nurses Society (INS) recommend replacing primary and secondary continuous infusion sets no more frequently than every 96 hours (four days). This extended interval is safe only when the IV system remains “closed,” meaning the connection is not repeatedly broken or manipulated. Research supports the 96-hour guideline, showing that more frequent changes do not decrease infection rates and may increase contamination risk during the change procedure. The tubing must always be changed immediately if contamination is suspected or if the integrity of the system is compromised, though in some low-risk situations, the interval may be extended up to seven days.
Protocols for High-Risk and Intermittent Infusions
Certain types of solutions and infusion methods promote rapid microbial growth, requiring much shorter tubing replacement intervals. These high-risk infusions include blood products and solutions containing fat emulsions. The Infusion Nurses Society and the Centers for Disease Control and Prevention (CDC) issue stringent guidelines for these specific cases.
Lipids and Fat Emulsions
Administration sets used for lipid-containing solutions, such as total parenteral nutrition (TPN) or intravenous fat emulsions (IVFE), must be changed every 24 hours. The high-fat content of these solutions is a rich nutrient source for bacteria, making the tubing highly susceptible to colonization. If a lipid emulsion is administered separately, some guidelines suggest changing the administration set every 12 hours due to the higher concentration of fat.
Blood and Blood Products
Blood and blood products, including packed red blood cells, require frequent set replacement because they are highly conducive to bacterial growth. The administration set must be changed after every unit transfused or within a maximum of four hours, whichever comes first. This short duration ensures that any bacteria introduced do not have adequate time to multiply to infectious levels within the tubing.
Intermittent Infusions
Intermittent infusions, often called “piggyback” infusions, have a distinct protocol because the tubing is manipulated more often. Intermittent administration sets, such as those used for antibiotics that are disconnected after each dose, must typically be changed every 24 hours. This daily replacement addresses the heightened risk of contamination that occurs with the repeated disconnection and reconnection of the set.