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“Since 2013, the shortage of non-additive glucose and saline intravenous solutions has been occurring intermittently and has caused uncertain supply and demand problems for hospitals and other medical institutions,” explained Dr. Therese B. Mianecki, a registered nurse. “Due to these shortages, many medical institutions have to modify policies and procedures related to the management of IV solutions, resulting in an increase in the maximum suspension time of non-additive IV from 24 hours to 96 hours. Although previous studies have examined and extended IV Patient safety is related to dosing suspension time, but few people have studied the relationship between prolonging the suspension time beyond 24 hours and the incidence of central venous catheter-associated bloodstream infection (CLABSI).”
Dr. Mianecki added that these infections will increase the morbidity, mortality, and related costs of patients diagnosed with CLABSI. It is estimated that the cost per patient is more than US$50,000 and more than US$2 billion per year.
Dr. Mianecki said that it is estimated that the daily demand for IV solution will reach hundreds or thousands, depending on the patient's census and acuity, so it is important to provide IV solution to meet the patient's fluid needs. “At the same time, patient safety is always the primary consideration in the daily decisions made by healthcare professionals (HCP), so while meeting the patient’s fluid needs, HCP also wants to ensure that care is not affected,” she said.
Comparison of CLABSI between groups is not significant
For a paper published in the Journal of Infusion Nursing, Dr. Mianecki and his colleague Dr. Edward L. Peterson investigated whether longer non-additive IV suspension times would increase the infection rate of patients. They conducted a retrospective chart review; the data came from the medical records of 2,967 inpatients admitted within 5 months of a 887-bed tertiary care hospital in the Midwest. Data includes length of stay, CLABSI incidence, admission diagnosis, gender, IV type and total IV suspension time (in hours), patient care unit, and patient age at admission. The researchers compared the incidence of CLABSI before (comparison) and after (intervention) that the IV suspension time was extended to 96 hours.
The results of the study show that increasing the hang time does not lead to a higher infection rate. "The comparison of the incidence of CLABSI between the intervention group and the control group was not significant," said Dr. Mianecki. "Therefore, this result adds to the evidence that the IV suspension time can be prolonged without worrying about the increase in the incidence of CLABSI." The researchers found five (0.27%) CLABSI in the intervention group, and the control group. Two (0.20%) CLABSI. Due to the small number of infections in the two groups, no statistical tests were performed (table). The latest news and update email ID is invalid. After registering, you will receive an email about Physician's Weekly products, and you agree to our terms and conditions and privacy policy.
The results can be generalized to similar settings
"Based on these findings, the current standard of care can be changed to reflect the safety of suspending non-additive IV solutions for up to 96 hours in adult patients," Dr. Mianecki concluded. "Extending the suspension time of the IV solution will also be synchronized with the recommended suspension time and the replacement of the IV tube drug delivery device, and minimize the risk of potential contamination that may occur when the IV delivery system is unnecessarily damaged to replace the solution."
In addition, Dr. Mianecki added that these findings may be extended to other similar health center populations and provide evidence to support policy changes in the duration of IV suspension. "Clinically, this study provides supporting evidence for healthcare managers and HCPs who are concerned about the safety of extending IV suspension and are seeking guidance to support policy changes," she said. "HCPs working in infusion centers can use these findings to help develop policies for similar groups of adult patients."
Dr. Mianecki and Peterson hope that future research will focus on bloodstream infections and adverse events related to short peripheral venous catheters (PIV). "Since PIV is the most commonly used intravenous catheter-millions of PIVs are inserted each year to transport blood, body fluids, and drugs-additional research in this area may help reduce the incidence of complications in related patients," Dr. Mianecki Say.
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