Frequent IV Tubing and Component Changes

To determine the effect of changing needleless connectors (NC) frequently on central line–associated bloodstream infections (CLABSI) rates

The study was conducted among pediatric bone marrow transplantation (BMT) recipients and the oncology unit population, and was conducted and evaluated in three interrupted times. In time period 1, the healthcare professionals changed needleless connectors (NC) every 96 hours regardless of the infusion of blood products, lipids/total parenteral nutrition (TPN), and IV amphotericin B. In period 2, they changed NC every 24 hours only with blood products and lipids/TPN. In period 3, they changed the NC every 96 hours regardless of infusate. Moreover, they collected data on central venous catheter (CVC) bundle access, which involves hand hygiene and cleaning connectors with alcohol for 15 seconds. In a different general oncology unit, healthcare workers change connectors every 24 hours across all study periods. 

• N = None given, 44 CLABSI episodes    
• AGE = Pediatric, no age specified
• MALES: Not specified, FEMALES: Not specified
• KEY DISEASE CHARACTERISTICS: Stem cell transplantation recipients and patients with cancer 
• OTHER KEY SAMPLE CHARACTERISTICS: Blood product transfusion, lipids transfusion, and infusion of IV liposomal amphotericin B

• SITE: Multi-site    
• SETTING TYPE: Inpatient    
• LOCATION: Boston, MA

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Pediatrics

• Retrospective cohort time series analysis

• Center for Disease Control (CDC) and the National Healthcare Safety Network (NHSN) guidelines for central venous catheter (CVC) care 
• CLABSI rate was number of infections per 1,000 central-line days
• CLABSI defined per National Healthcare Safety Network definitions

According to CDC and NHSN guidelines, NC should be changed every 24 hours, but this study suggests that frequent NC changes may increase the rate of CLABSI.

• Small sample (< 100)
• Risk of bias (sample characteristics)
• Measurement validity/reliability questionable
• Sample size was not described appropriately.
• Method of data collection and measurement for unit adherence to catheter care bundle guidelines was not described.

Nurses should follow CVC access bundle (i.e., hand hygiene, cleaning the NC with alcohol for 15 seconds) while handling CVCs. In addition, organizational policies may help decrease CLABSI and other infections among BMT recipients and patients with cancer as they are at a very high risk of acquiring bloodstream infections. The appropriate frequency of changing all IV line components is unclear. Additional research is needed to establish the evidence base for some infection prevention guidelines.

To provide evidence-based recommendations for the prevention of intravascular catheter-related infections for healthcare personnel who insert and care for intravascular catheters and for those responsible for surveillance and infection control in hospital, outpatient, and home health settings. Patients addressed in the guidelines were adult and pediatric patients with intravascular catheters.

The resource is comprised of evidence-based guidelines. For the development process, evidence was categorized as category 1A to category 2 based on strength of recommendation and support from clinical or epidemiological studies.

• Patients were undergoing multiple phases of care.
• The study has clinical applicability for pediatrics. 

The results were not summarized.

The guidelines provided extensive recommendations regarding the education and training of staff; selection of catheters and sites, including avoidance of the femoral vein for central venous access and use of the central venous catheter with the minimum number of ports needed; hand hygiene; use of maximal sterile barrier precautions for insertion; skin preparation with alcohol, iodine, or chlorhexidine; use of standard catheter site dressing regimens; specific aspects of care for umbilical and dialysis catheters; and use of piggybacks, stopcocks, and catheter flushing. Guideline recommendations include a bundling of multiple recommendations: antimicrobial-impregnated catheters and cuffs are recommended in patients with long-term use if the organizational central line-associated blood stream infection (CLABSI) rate is not decreasing despite the implementation of comprehensive strategies for improvement. Lower-level (category II) recommendations include the use of prophylactic antimicrobial lock solutions in patients with long-term catheters who have a history of CLABSIs despite optimal aseptic technique as well as daily cleansing of patients in the intensive care unit with 2% chlorhexidine-impregnated washcloths. Recommends changing IV administration sets no more often than every 96 hours unless used for blood products. For needleless components, recommends changing according to administration set timing as above, and states no benefit to changing more than every 72 hours.

Provides extensive recommendations for management of all types of intravenous catheters and system components. Nurses should refer to the full set of guidelines for all specific aspects of care.