Site Care and Maintenance
Administration Set Change
Policy
Administration sets, including add-on devices, will be changed at established intervals depending on the type of administration and infusate.
Administration set changes, including add-on devices, will coincide with peripheral vascular access device replacement and central vascular access device insertion.
Administration sets, including add-on devices, will be changed immediately when contamination is suspected or when product integrity is compromised.
Administration sets used with lipid-based infusâtes, such as intravenous fat emulsions (IVFE), will be free of di-ethylhexyl-phthalate (DEHP).
Supplies
Antiseptic wipes (eg, alcohol)
Prescribed infusate
Administration set
Add-on devices (eg, needleless connector, extension set, filter)
Label
Procedure
Perform hand hygiene.
Inspect supplies for integrity and sterility.
Infusate
Administration set
Add-on devices
Assemble administration set.
Close clamp on new administration tubing
Attach add-on devices to administration set
Prepare solution container.
Remove protective covers from administration set’s spike and infusâte’s access port
Insert spike into solution container
Hang container (for an ambulatory electronic infusion device [EID], place container in carrying case)
Prime new administration set, including add-on devices and extension tubing.
Squeeze drip chamber to fill to manufacturer’s mark (approximately one-third to one-half full)
Slowly open clamp to prime administration set while holding distal end of administration set upright, allowing filter to hang upsidedown
Prime entire length of administration set, and clamp
Note for ambulatory EID: infusate may need to be primed using pump-priming function
Connect administration set to existing catheter:
Clamp existing administration set
Clamp catheter to prevent accidental exposure to blood and to reduce risk for air embolism, and disconnect from catheter hub
Disinfect catheter hub with antiseptic wipes
Remove protective cap from distal end of administration set and attach to catheter hub
Unclamp catheter to resume infusion
Discard existing administration set and infusate
Begin infusion.
Slowly open clamp of administration set to begin infusion or turn on EID
Monitor drops per minute manually by counting drops to ensure proper administration rate, or observe EID for 1-2 minutes to ensure proper administration rate
Label administration set with date and time.
Perform hand hygiene.
Table 1. Administration Set Change Frequency by Administration Type | |||||||||
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Table 2. Administration Set Change Frequency by Infusate | ||||||||||||||||||||||
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Bibliography
AABB. Standards for Blood Banks and Transfusion Services. 26th ed. Bethesda, MD: AABB; 2009.
Hadaway L. Infusion therapy equipment. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:391-436.
Institute for Safe Medication Practices. Failure to cap IV tubing and disconnect IV ports place patients at risk for infections. Medication Safety Alert. http://www.ismp.org/newslet ters/acutecare/articles/20070726.asp. Published July 26, 2007. Accessed June 17, 2010.
Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. J Parenter Enteral Nutr. 2004; 28(suppl):S39-S70.
Phillips LD. Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy. 5th ed. Philadelphia, PA: FA Davis; 2010:239-248.
Flushing and Locking
Policy
Flushing is performed prior to each infusion to assess vascular access device (VAD) function, after each infusion to prevent mixing of incompatible medications and solutions, and after blood sampling.
Locking is performed to maintain device patency and prevent occlusion by instilling solution in an intermittently used VAD.
Single-use flushing and locking systems will be used.
A VAD should never be forcibly flushed. To prevent damage, the patency of the VAD should be assessed using a 10-mL syringe.
Supplies
Gloves
Antiseptic wipes (eg, alcohol)
Preservative-free 0.9% sodium chloride (USP) prefilled syringe(s)
Heparin lock solution (10-100 units/mL) prefilled syringe(s)
10-mL syringe(s)
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