NUR 141: SKILL 28-4: CHANGING INFUSION TUBING

1. NUR 141: SKILL 28-4: CHANGING INFUSION TUBING

2. CHANGING INFUSION TUBING - INTRODUCTION • An important component of patient care is maintaining the integrity of the intravenous (IV) system through the conscientious use of infection-prevention principles. • Administration sets are the primary method to carry a solution or medication to a patient. • These administration sets are considered the primary set. In addition, patients may have add-on devices (e.g., filters, extension sets) which you connect to the primary set as indicated by the prescribed therapy. • Secondary sets may be used as a method to administer additional medications in conjunction with the primary infusion (e.g. antibiotics). • Administration sets used for parenteral nutrition and blood or blood products have specific criteria with which you need to be familiar when administrating these advanced therapies. • Whenever possible, schedule tubing changes when it is time to hang a new IV container.

3. ASSESSMENT • 1. Note date and time when IV tubing was last changed. • 2. Assess tubing for puncture, contamination, or occlusion that requires immediate change • 3. Determine patient’s understanding of need for continued IV therapy.

4. PLANNING • 1. Expected outcomes following the completion of the procedure: • Patient’s IV site is free from signs & symptoms of IV-related complications (e.g., infection, redness, swelling, or pain). • Patient experiences no leakage of solution from or around IV tubing. • Patient’s IV tubing is patent • Patient & family caregiver explain procedure, purpose, and patient expectations – this demonstrates learning.

5. IMPLEMENTATION • 1. Identify patient using at least two identifiers (i.e., name and birthday or name and account number) according to agency policy. Compare identifiers with information on patient’s identification bracelet. • 2. Prepare the patient by explaining procedure, its purpose, and what is expected of them. • 3. Coordinate tubing changes with solution changes when possible. • 4. Perform hand hygiene. • 5. Open new infusion set and connect add-on pieces (e.g., filters, extension tubing). Keep protective covering over infusion spike and distal adapter. Secure all connections.

6. IMPLEMENTATION – CONT’D • 6. Apply clean gloves. If patient’s IV cannula hub is not visible, remove IV dressing. Do not remove tape securing the cannula to the skin. • 7. Prepare infusion tubing with new bag. (See Skill 28-1, Step 8). • 8. Prepare infusion tubing with existing continuous IV infusion bag. • A. Move roller clamp on new IV tubing to “off” position. • B. Slow rate of infusion through old tubing to KVO rate, using EID or roller clamp. • C. Compress and fill drip chamber of old tubing. • D. Invert container and remove old tubing. Keep spike sterile and upright. Optional: Tape old drip chamber to IV pole without contaminating spike.

7. IMPLEMENTATION – CONT’D • E. Place insertion spike of new tubing into solution container. Hang solution bag on IV pole, compress and release drip chamber on new tubing, and fill drip chamber one-third to one-half full. • F. Slowly open roller clamp, remove protective cap from adapter (if necessary), and prime new tubing with solution. Stop infusion and replace cap. Place end of adapter near patient’s IV site. • G. Stop EID or turn roller clamp on old tubing to “off” position. • 9. Prepare tubing with extension set or saline lock. • A. If short extension tubing is needed, use sterile technique to connect new injection cap to new extension set or tubing. • B. Swab injection cap with antiseptic swab. Insert syringe with 3 to 5 mL of saline solution and inject through injection cap into extension set

8. IMPLEMENTATION – CONT’D • 10. Re-establish infusion. • A. Gently disconnect old tubing from extension tubing (or from IV catheter hub) and quickly insert adapter of new tubing or saline lock into extension tubing, connection (or IV catheter hub) • B. For continuous infusion, open roller clamp on new tubing and regulate drip rate using roller clamp or EID – this ensures catheter patency and prevents occlusion. • C. Attach piece of tape or preprinted label with date and time of tubing change onto tubing below drip chamber. • D. Form loop of tubing and secure it to the patient’s arm with a strip of tape – this avoids accidental pulling against site and it stabilizes the catheter. • 11. Remove and discard old IV tubing. If necessary, apply new dressing. Remove and dispose of gloves. Perform Hand hygiene.

9. EVALUATION • 1. Evaluate flow rate hourly and observe connection site for leaking. – The ensure proper fluid administration • 2. Observe patient for signs of fluid volume deficit (FVD) or fluid volume excess (FVE) to determine response to IV therapy. – This provides ongoing evaluation of patient’s fluid and electrolyte status • 3. Check entire IV system for patency, starting with solution bag hanging and working all the way down system to patient’s IV access insertion site – This prevents improper fluid infusion.

10. UNEXPECTED OUTCOMES • 1. IV infusion is slower than ordered: • RELATED INTERVENTIONS: • Check for positional change that affect rate, height of IV container, kinking of tubing or obstruction. • Check for patency by opening the roller clamp. • Check VAD site for complications • Consult health care provider for new order to provide necessary fluid volume

11. RECORDING & REPORTING • Record tubing change, type of solution, volume, and rate of infusion on patient’s record. • Use a special IV therapy flow sheet for parenteral fluids per agency policy. • SPECIAL CONSIDERATION TEACHING: Instruct the patient to notify the nurse if fluid leaks from or around the IV site or if the tubing separates from the catheter.

12. END OF SKILL • THIS IS THE END OF THE SKILL • Your book has not provided a video for this skill • I have found one on you tube and here is a copy of the link for it: • COD IV solution and tubing change review • http://www.youtube.com/watch?v=MpVsSM3w25U

13. ADMINISTRATION SET CHANGES • PRIMARY AND SECONDARY CONTINUOUS INFUSIONS: • Every 96 hours for fluids other than lipid, blood, or blood products. • Extending to every 7 days may be considered if an anti-infective CVAD is being used and if fluids that enhance microbial growth are not administered (less than 10% dextrose solutions). • If the secondary set is removed from the primary set, the secondary set is now considered an intermittent set and should be changed every 24 hours.

14. ADMINISTRATIVE SET CHANGES- CONT’D • PRIMARY INTERMITTENT INFUSIONS • Should be changed every 24 hours because of the increased risk of infection with repeatedly disconnecting and reconnecting administration set. • Aseptically attach a covering device to the end of the administration set after each intermittent use. Avoid attaching the exposed end of the administration set to port on the same set (e.g., looping).

15. ADMINISTRATION SET CHANGES – CONT’D • USE OF ADD-ON DEVICES: • Should be minimized since each is a potential source of contamination and disconnection. • Use of administration sets with devices as part of the set is preferred. • Aseptically change with insertion of new short peripheral catheter or with each administration set replacement. • End of Power-Point Presentation – Again, I have supplied a video for you to watch, regarding this skill, but I found it and it was not provided to you by the school. • In order to pass this skill, you need to practice it in the skills lab, but please feel free to review the power-point presentation as much as needed. • Thank you.