The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [572]
It is desirable that a closed system of infusion is maintained wherever possible, with as few connections as is necessary for its purpose (Finlay 2008, Hart 2008). This reduces the risk of bacterial contamination. Any extra connections within the administration system increase the risk of infection. Three-way taps have been shown to encourage the growth of micro-organisms. They are difficult to clean due to their design, as micro-organisms can become lodged and are then able to multiply in the warm, moist environment (Finlay 2008, Hart 2008). This reservoir for micro-organisms may then be released into the circulation.
The injection sites on administration sets or injection caps should be cleaned using a 2% chlorhexidine alcohol-based antiseptic, allowing time for it to dry (Pratt et al. 2007). Connections should be cleaned before changing administration sets and manipulations kept to a minimum. Administration sets should be changed according to use (intermittent/continuous therapy), type of device and type of solution, and the set must be labelled with the date and time of change (NPSA 2007d, RCN 2010).
To ensure safe delivery of intravenous fluids and medication:
replace all tubing when the vascular device is replaced (Pratt et al. 2007)
replace solution administration sets and stopcocks used for continuous infusions every 72 hours unless clinically indicated, for example, if drug stability data indicate otherwise (Pratt et al. 2007, RCN 2010). Research has indicated that routine changing of administration sets (used for infusing solutions) every 48–72 hours instead of every 24 hours is not associated with an increase in infection and could result in considerable savings for hospitals (Pratt et al. 2007, RCN 2010)
replace solution administration sets used for lipid emulsions and parenteral nutrition at the end of the infusion or within 24 hours of initiating the infusion (Pratt et al. 2007, RCN 2010). Certain intravenous fluids including lipid emulsions, blood and blood products are more likely than other parenteral fluids to support microbial growth if contaminated and therefore replacement of the intravenous tubing is required more frequently than 48–72 hours (Pratt et al. 2007)
replace blood administration sets at least every 12 hours and after every second unit of blood (McClelland 2007, Pratt et al. 2007, RCN 2010)
all solution sets used for intermittent infusions, for example antibiotics, should be discarded immediately after use and not allowed to hang for reuse (RCN 2010).
if administering more than one infusion via a multi lumen extension set or multipl ports, be aware of the risk of back tracking of medication and consider using sets with one way, non return or anti reflux valves (MHRA 2010a).
Inspection of fluids, drugs, equipment and their packaging must be undertaken to detect any points where contamination may have occurred during manufacture and/or transport. This intrinsic contamination may be detected as cloudiness, discoloration or the presence of particles (BNF 2011, RCN 2010, Weinstein and Plumer 2007). Infusion bags should not be left hanging for longer than 24 hours. In the case of blood and blood products, this is reduced to 5 hours (McClelland 2007, RCN 2010).
Safety
All details of the prescription and all calculations must be checked carefully in accordance with hospital policy in order to ensure safe preparation and administration of the drug(s).
The nurse must also check the compatibility of the drug with the diluent or infusion fluid. The nurse should be aware of the types of incompatibilities and the factors which could influence them. These include pH, concentration, time, temperature, light and the brand of the drug. If insufficient information is available, a reference book (e.g. British National Formulary) or the product data sheet must be consulted (NPSA 2007d, Whittington 2008). If the nurse is