CVAD intravenous administration sets

Section Recommendation statement Grading
22.

Intravenous administration sets attached to a CVAD must be attached to the patient so that no tension is applied to the catheter  to reduce risk of dislodgement.


Consensus
23. Administration sets (burettes, administration sets, multi-flow adapters, caps, connectors, extension devices) that are attached to antimicrobial or antibiotic-coated multi-lumen CVAD should be changed either after seven days or when clinically indicated (e.g. precipitate, particulate matter, blood in administration set, faulty set), or when the catheter is changed (1). This excludes blood products and lipids. Grade B
24. Administration sets (burettes, infusion sets, multi-flow adapters, caps, connectors, extension devices) attached to standard CVADs should be changed either after 96 hours, or when clinically indicated (e.g. precipitate, particulate matter or blood in apparent in the administration set or the set is faulty), or when the catheter is changed. This excludes blood products and lipids (2-5). Grade B
25. Administration sets for lipid-based emulsions should be changed within 24 hours of starting the infusion or as recommended by the manufacturer. Grade A
The evidence review for these recommendations was current to December 2012. Clinicians are advised to check the literature as research may have been published that change these recommendations.

A number of potential problems can occur if tension is applied to the intravenous administration sets attached to a CVAD . These include: 1) pain and discomfort for the patient; 2) partial or total catheter dislodgment resulting in failure to administer intended therapies and/or need for catheter replacement; 3) the risk of extravasation injury with extra luminal infusion; and 4) lifting of the dressing which creates an entry point for organisms. For these reasons the Guideline Development Network members felt that it is important that the administration sets are also secured to the patient and not the bed or the patient’s clothing.

Administration sets

The relevant research informing practice in relation to administration set changes was included in the 2007 version of the ICCMU CVAD guideline and these recommendations remain unchanged. However the practice review in NSW indicated that despite the introduction of the initial ICCMU guideline, administration set changes are commonly performed more frequently than recommended which may place the patient at increased risk and definitely results in increased costs (4).

The additional guideline used to support the current version of the recommendations is the updated 2011 Centers for Disease Control and Prevention (CDC) recommendations. The CDC supports the practice of administration set change between four and seven days except for blood and lipid-containing infusions (1). The practice of four and seven day administration set changes, including all types of administration sets attached to different vascular devices, is currently the subject of a large randomised controlled trial in Australia. This study is now recruiting patients and is expected to further inform this recommendation in the future.

Practice point - Disconnecting IV administration sets

It is not acceptable to disconnect and reconnect the same administration set. The rationale for not disconnecting is to reduce opportunities for infection and/or error. The disconnection/reconnection process has many points where risk is apparent. It is, however, important to assess the ongoing need for infusion therapy and only disconnect for routine administration set changes or to cease therapy.

Grading of recommendations

Grade of recommendation Description
A Body of evidence can be trusted to guide evidence
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation/s but care should be taken in its application
D Body of evidence is weak and recommendation must be applied with caution
Consensus Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (6)

References

  1. O'Grady N, Alexander M, Burns LA, Dellinger P, Garland J, Heard SO, et al. Guidelines for the Prevention of Intravascular Catheter Related Blodd Stream Infections. In: Control CfD, editor. 2011.
  2. Gillies D, O'Riordan L, Wallen M, Morrison A, Rankin K, Nagy S. Optimal timing for intravenous administration set replacement. Cochrane Database of Systematic Reviews. 2007 (4):CD003588. PubMed PMID: 16235329.
  3. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection. 2007;65 Suppl 1:S1-64. PubMed PMID: 17307562.
  4. Raad I, Hanna HA, Awad A, Alrahwan A, Bivins C, Khan A, et al. Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours? Infection Control & Hospital Epidemiology. 2001;22(3):136-9. PubMed PMID: 11310690.
  5. Rickard CM, Lipman J, Courtney M, Siversen R, Daley P. Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters. Infection Control & Hospital Epidemiology. 2004;25(8):650-5. PubMed PMID: 15357156.
  6. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.