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October 2, 1987, Vol 258, No. 13 >
ARTICLE | October 2, 1987

Prospective Study of Replacing Administration Sets for Intravenous Therapy at 48- vs 72-Hour Intervals: Title and subTitle Break72 Hours Is Safe and Cost-effective FREE

Dennis G. Maki, MD; Joseph T. Botticelli, MS; Marie L. LeRoy, MS; Thomas S. Thielke, MS
[+] Author Affiliations

Presented in part at the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, Oct 1, 1986.

Reprint requests to University of Wisconsin Hospital and Clinics-H4/574, Madison, WI 53792 (Dr Maki).


JAMA. 1987;258(13):1777-1781. doi:10.1001/jama.1987.03400130091039
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Article
References

We prospectively studied the safety of replacing intravenous delivery systems, including those used in total parenteral nutrition, at 72- compared with 48-hour intervals in 487 patients. Although the prevalence of contamination of intravenous fluid was higher in administration sets replaced at 72-hour intervals (10/664,1.5%) than in sets replaced every 48 hours (6/710,0.8%), the difference is not statistically significant. Contamination in both groups was almost exclusively with small numbers of coagulase-negative staphylococci (range, 1 to 27 colony-forming units/mL); no contaminated infusion was associated with clinical signs of sepsis or concordant bacteremia. Contaminants were recovered less frequently from peripheral venous infusions (0.6%) than from infusions used for central venous access or hemodynamic monitoring (1.5%) or total parenteral nutrition (3.6%); infusions in an intensive care unit were more frequently contaminated (2.5%) than infusions on medical and surgical wards (0.9%). These data indicate that extrinsic contamination of intravenous fluid is a rare cause of endemic nosocomial septicemia, and for most infusions it is unnecessary to routinely replace delivery systems more frequently than every 72 hours.

(JAMA 1987;258:1777-1781)

REFERENCES

1 +
Maki DG, Goldman DA, Rhame FS:  Infection control in intravenous therapy . Ann Intern Med 1973;;79:876-887.
2 +
Maki DG:  Infections associated with intravascular lines , in Swartz M, Remmington J (eds): Current Topics in Clinical Infectious Disease . New York, McGraw-Hill Inc, 1982;, pp 309-363.
3 +
Goldman DA, Maki DG, Rhame FS, et al:  Guidelines for infection control in intravenous therapy . Ann Intern Med 1973;;79:848-850.
4 +
National Coordinating Committee on Large Volume Parenterals:  Recommended methods for compounding intravenous admixtures in hospitals . Am J Hosp Pharm 1975;;32:261-270.
5 +
Centers for Disease Control Working Group:  Guidelines for prevention of intravenous therapy-related injections . Infect Control 1981;;3:62-79.
6 +
Maki DG:  Sepsis arising from extrinsic contamination of the infusion and measures for control , in Phillips I (ed): Microbiological Hazards of Infusion Therapy . Lancaster, England, MTP Press Ltd, 1977;, 99-141.
7 +
Maki DG, Martin WT:  Nationwide epidemic of septicemia caused by contaminated infusion products: IV. Growth of microbial pathogens in fluids for intravenous infusion . J Infect Dis 1975;;131:267-272.
8 +
Maki DG, Rhame FS, Mackel D, et al:  Nation-wide epidemic of septicemia caused by contaminated intravenous products . Am J Med 1976;;60: 471-485.
9 +
 Nosocomial bacteremia associated with intravenous fluid therapy . MMWR 1971;;20( (suppl 9) ):1-2.
10 +
Buxton AE, Highsmith AK, Garner JS, et al:  Contamination of intravenous fluid: Effects of changing administration sets . Ann Intern Med 1979;;90:764-768.
11 +
Band JD, Maki DG:  Safety of changing intravenous delivery systems at longer than 24-hour intervals . Ann Intern Med 1979;;91:173-178.
12 +
Gorbea HF, Snydman DR, Delaney A, et al:  Intravenous tubing with burettes can be safely changed at 48-hour intervals . JAMA 1984;;251:2112-2115.
13 +
Lennette E, Balows A, Hausler W, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980;.
14 +
Maki DG, Weise CE, Sarafini HW:  A semiquantitative culture method for identifying intravenouscatheter—related infection . N Engl J Med 1977;;296: 1305-1309.
15 +
Josephson A, Gombert ME, Sierra MF, et al:  The relationship between intravenous fluid contamination and the frequency of tubing replacement . Infect Control 1985;;6:367-370.
16 +
Snydman DR, Reidy MD, Perry LK, et al:  Safety of changing intravenous (IV) administration sets containing burettes at longer than 48 hour intervals . Infect Control 1987;;8:113-116.
17 +
Haley RW:  The surveyance of infection surveillance and control programs in US hospitals: An assessment, 1976 . Am J Epidemiol 1980;;111:574-591.
18 +
Melly MA, Meng HC, Schaffner W:  Microbial growth of lipid emulsions used in parenteral nutrition . Arch Surg 1985;;110:1479-1481.
19 +
Crocker KS, Noga R, Filibeck DJ, et al:  Microbial growth comparisons of five commercial parenteral lipid emulsions . J Parenter Enteral Nutr 1984;;8:391-394.
20 +
McKee KT, Melly MA, Greene HL, et al:  Gram-negative bacillary sepsis associated with use of lipid emulsion in parenteral nutrition . AJDC 1979;;133: 649-650.
21 +
Jarvis WR, Highsmith AK, Allen JR, et al:  Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit . Pediatr Infect Dis 1983;;2:203-209.
22 +
Maki DG, Hassemer CH:  Endemic rate of fluid contamination and related septicemia in arterial pressure monitoring . Am J Med 1981;;70:733-738.
23 +
Platzner N, Marino JA, Cerra FB, et al:  Eliminating the cul-de-sac from pressure cone infusion systems reduces fluid contamination . Proceedings of the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, Oct 6, 1982 .
24 +
Shinozaki T, Deane RS, Mazuzan JE, et al:  Bacterial contamination of arterial lines . JAMA 1983;;249:223-225.
25 +
Luskin RL, Weinstein, RA, Nathan C, et al:  Extended use of disposable pressure transducers: A bacteriologic evaluation . JAMA 1986;;255:916-920.
26 +
Goldmann DA, Martin WT, Worthington JW:  Growth of bacteria and fungi in total parenteral nutrition solutions . Am J Surg 1973;;126:314-318.
27 +
Plouffe JF, Brown DG, Silva J Jr, et al:  Nosocomial outbreak of Candida parapsilosis fungemia related to intravenous infusions . Arch Intern Med 1977;;137:1686-1689.
28 +
Solomon SL, Khabbaz RF, Parker RH, et al:  An outbreak of Candida parapsilosis bloodstream infections in patients receiving parenteral nutrition . J Infect Dis 1984;;149:98-102.
29 +
Sanderson I, Deitel M:  Intravenous hyperalimentation without sepsis . Surg Gynecol Obstet 1973;;136:577-585.
30 +
Freeman JB, Litton AA:  Preponderance of gram-positive infections during parenteral alimentation . Surg Gynecol Obstet 1974;;139:905-908.
31 +
Deitel M, Krajden S, Saldanha CF, et al:  An outbreak of Staphylococcus epidermidis septicemia . J Parenter Enteral Nutr 1983;;7:569-572.

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1 +
Maki DG, Goldman DA, Rhame FS:  Infection control in intravenous therapy . Ann Intern Med 1973;;79:876-887.
2 +
Maki DG:  Infections associated with intravascular lines , in Swartz M, Remmington J (eds): Current Topics in Clinical Infectious Disease . New York, McGraw-Hill Inc, 1982;, pp 309-363.
3 +
Goldman DA, Maki DG, Rhame FS, et al:  Guidelines for infection control in intravenous therapy . Ann Intern Med 1973;;79:848-850.
4 +
National Coordinating Committee on Large Volume Parenterals:  Recommended methods for compounding intravenous admixtures in hospitals . Am J Hosp Pharm 1975;;32:261-270.
5 +
Centers for Disease Control Working Group:  Guidelines for prevention of intravenous therapy-related injections . Infect Control 1981;;3:62-79.
6 +
Maki DG:  Sepsis arising from extrinsic contamination of the infusion and measures for control , in Phillips I (ed): Microbiological Hazards of Infusion Therapy . Lancaster, England, MTP Press Ltd, 1977;, 99-141.
7 +
Maki DG, Martin WT:  Nationwide epidemic of septicemia caused by contaminated infusion products: IV. Growth of microbial pathogens in fluids for intravenous infusion . J Infect Dis 1975;;131:267-272.
8 +
Maki DG, Rhame FS, Mackel D, et al:  Nation-wide epidemic of septicemia caused by contaminated intravenous products . Am J Med 1976;;60: 471-485.
9 +
 Nosocomial bacteremia associated with intravenous fluid therapy . MMWR 1971;;20( (suppl 9) ):1-2.
10 +
Buxton AE, Highsmith AK, Garner JS, et al:  Contamination of intravenous fluid: Effects of changing administration sets . Ann Intern Med 1979;;90:764-768.
11 +
Band JD, Maki DG:  Safety of changing intravenous delivery systems at longer than 24-hour intervals . Ann Intern Med 1979;;91:173-178.
12 +
Gorbea HF, Snydman DR, Delaney A, et al:  Intravenous tubing with burettes can be safely changed at 48-hour intervals . JAMA 1984;;251:2112-2115.
13 +
Lennette E, Balows A, Hausler W, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980;.
14 +
Maki DG, Weise CE, Sarafini HW:  A semiquantitative culture method for identifying intravenouscatheter—related infection . N Engl J Med 1977;;296: 1305-1309.
15 +
Josephson A, Gombert ME, Sierra MF, et al:  The relationship between intravenous fluid contamination and the frequency of tubing replacement . Infect Control 1985;;6:367-370.
16 +
Snydman DR, Reidy MD, Perry LK, et al:  Safety of changing intravenous (IV) administration sets containing burettes at longer than 48 hour intervals . Infect Control 1987;;8:113-116.
17 +
Haley RW:  The surveyance of infection surveillance and control programs in US hospitals: An assessment, 1976 . Am J Epidemiol 1980;;111:574-591.
18 +
Melly MA, Meng HC, Schaffner W:  Microbial growth of lipid emulsions used in parenteral nutrition . Arch Surg 1985;;110:1479-1481.
19 +
Crocker KS, Noga R, Filibeck DJ, et al:  Microbial growth comparisons of five commercial parenteral lipid emulsions . J Parenter Enteral Nutr 1984;;8:391-394.
20 +
McKee KT, Melly MA, Greene HL, et al:  Gram-negative bacillary sepsis associated with use of lipid emulsion in parenteral nutrition . AJDC 1979;;133: 649-650.
21 +
Jarvis WR, Highsmith AK, Allen JR, et al:  Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit . Pediatr Infect Dis 1983;;2:203-209.
22 +
Maki DG, Hassemer CH:  Endemic rate of fluid contamination and related septicemia in arterial pressure monitoring . Am J Med 1981;;70:733-738.
23 +
Platzner N, Marino JA, Cerra FB, et al:  Eliminating the cul-de-sac from pressure cone infusion systems reduces fluid contamination . Proceedings of the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, Oct 6, 1982 .
24 +
Shinozaki T, Deane RS, Mazuzan JE, et al:  Bacterial contamination of arterial lines . JAMA 1983;;249:223-225.
25 +
Luskin RL, Weinstein, RA, Nathan C, et al:  Extended use of disposable pressure transducers: A bacteriologic evaluation . JAMA 1986;;255:916-920.
26 +
Goldmann DA, Martin WT, Worthington JW:  Growth of bacteria and fungi in total parenteral nutrition solutions . Am J Surg 1973;;126:314-318.
27 +
Plouffe JF, Brown DG, Silva J Jr, et al:  Nosocomial outbreak of Candida parapsilosis fungemia related to intravenous infusions . Arch Intern Med 1977;;137:1686-1689.
28 +
Solomon SL, Khabbaz RF, Parker RH, et al:  An outbreak of Candida parapsilosis bloodstream infections in patients receiving parenteral nutrition . J Infect Dis 1984;;149:98-102.
29 +
Sanderson I, Deitel M:  Intravenous hyperalimentation without sepsis . Surg Gynecol Obstet 1973;;136:577-585.
30 +
Freeman JB, Litton AA:  Preponderance of gram-positive infections during parenteral alimentation . Surg Gynecol Obstet 1974;;139:905-908.
31 +
Deitel M, Krajden S, Saldanha CF, et al:  An outbreak of Staphylococcus epidermidis septicemia . J Parenter Enteral Nutr 1983;;7:569-572.

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