Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-30T20:24:38.783Z Has data issue: false hasContentIssue false
  • English
  • Français

A Randomized Trial of 72- Versus 24-Hour Intravenous Tubing Set Changes in Newborns Receiving Lipid Therapy

Published online by Cambridge University Press:  02 January 2015

Anne G. Matlow ,
Ian Kitai ,
Haresh Kirpalani ,
Nicola H. Chapman ,
Mary Corey ,
Max Perlman ,
Paul Pencharz ,
Sue Jewell ,
Cindy Phillips-Gordon  and
Richard Summerbell
...Show all authors
Anne G. Matlow*
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Ian Kitai
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
Haresh Kirpalani
Affiliation:
Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Nicola H. Chapman
Affiliation:
Department of Biostatistics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Mary Corey
Affiliation:
Department of Biostatistics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Max Perlman
Affiliation:
Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Paul Pencharz
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Sue Jewell
Affiliation:
Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
Cindy Phillips-Gordon
Affiliation:
Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
Richard Summerbell
Affiliation:
Ministry of Health Laboratory Services Branch, Toronto, Ontario, Canada
E. Lee Ford-Jones
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
*
Department of Pediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare the microbial contamination rate of infusate in the intravenous tubing of newborns receiving lipid therapy, replacing the intravenous delivery system at 72-hour versus 24-hour intervals.

Design:

Infants requiring intravenous lipid therapy were randomly assigned to have intravenous sets changed on a 72- or a 24-hour schedule, in a 3:1 ratio, in order to compare the infusate contamination rates in an equivalent number of tubing sets.

Setting:

A 35-bed, teaching, referral, neonatal intensive-care unit (NICU).

Participants:

All neonates admitted to the NICU for whom intravenous lipid was ordered.

Methods:

Patients were randomized in pharmacy, on receipt of the order for intravenous lipid therapy, to either 72- or 24-hour administration set changes, and followed until 1 week after discontinuation of lipids or discharge from the NICU. Microbial contamination of the infusate was assessed in both groups at the time of administration set changes. Contamination rates were analyzed separately for the lipid and amino acid-glucose tubing sets. Patient charts were reviewed for clinical and epidemiological data, including birth weight, gestational age, gender, age at start of lipid therapy, duration of parenteral nutrition, and type of intravenous access.

Results:

During the study period, 1,101 and 1,112 sets were sampled in the 72- and 24-hour groups, respectively. Microbial contamination rates were higher in die 72-hour group than the 24-hour group for lipid infusions (39/1,101 [3.54%] vs 15/1,112 [1.35%]; P=.001) and for amino acid infusions (12/1,093 [1.10%] vs 4/1,103 [0.36%]; P=.076). Logistic regression analysis controlling for birth weight, gestational age, and type of venous access showed that only the tubing change interval was significanfly associated with lipid set contaminations (odds ratio, 2.69; P=.0013). The rate of blood cultures ordered was higher in die 72-versus the 24-hour group (6.11 vs 4.99 per 100 patient days of total parenteral nutrition; P=.017), and a higher proportion of infants randomized to the 72-hour group died (8% vs 4%; P=.05), although the excess deaths could not clearly be attributed to bacteremia.

Conclusion:

Microbial contamination of infusion sets is significantiy more frequent with 72- than witii 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 7 , July 1999 , pp. 487 - 493
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Maki, D, Botticelli, J, LeRoy, M, Theikle, T. Prospective study of replacing administration sets for intravenous therapy at 48 vs 72-hour intervals. JAMA 1987;258:1777–1781.CrossRefGoogle ScholarPubMed
2.Band, J, Maki, D. Safety of changing intravenous delivery systems at longer than 24 hour intervals. Ann Intern Med 1979;91:173–178.CrossRefGoogle ScholarPubMed
3.Buxton, AE, Highsmith, AK, Garner, JS, West, CM, Stamm, WE, Dixon, RE, et al. Contamination of intravenous fluid, effect of changing administration sets. Ann Intern Med 1979;90:764–768.CrossRefGoogle ScholarPubMed
4.Gorbea, H, Snydman, D, Delaney, A, Stockman, J, Martin, W. Intravenous tubing with burettes can be safely changed at 48 hour intervals. JAMA 1984;251:2112–2115.CrossRefGoogle ScholarPubMed
5.Josephson, A, Gombert, M, Sierra, M, Karanfil, L, Tansino, G. The relationship between intravenous fluid contamination and the frequency of tubing replacement. Infect Control 1985;6:367–370.CrossRefGoogle ScholarPubMed
6.Pearson, ML, the Hospital Infection Control Practices Advisory Committee. Guidelines for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:435–473.Google ScholarPubMed
7.Balows, AHausler, WS, Herrman, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology, 5th ed. Washington, DC: American Society for Microbiology; 1991.Google Scholar
8.Zeger, SL, Liang, KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–130.CrossRefGoogle ScholarPubMed
9.Maki, DG, Rhame, FS, Mackel, DC, Bennett, JV. Nationwide epidemic of septicemia caused by contaminated intravenous products. Am J Med 1976;60:471–485.CrossRefGoogle ScholarPubMed
10.Freeman, J, Goldmann, D, Smith, N, Sidebottom, D, Epstein, M, Piatt, R. Association of intravenous lipid emulsion and coagulase negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 1990;323:301–308.CrossRefGoogle ScholarPubMed
11.Mendelman, PM, Clausen, C, Spath, L, Wentz, K, Bakke, K, Wachs, T, Kushmerick, P. Lack of in vivo contamination of intralipid (IL) infusate. Presented at the Third International Conference on Nosocomial Infections; 1991; Atlanta, Georgia. Abstract B/28.Google Scholar
12.Linares, J, Sitges-Serra, A, Garau, J, Perez, J, Martin, R. Pathogenesis of catheter sepsis: a prospective study of quantitative and semi-quantitative cultures of catheter hub and segments. J Clin Microbiol 1985;21:357–360.CrossRefGoogle Scholar
13.Sitges-Serra, A, Linares, J, Perez, J, Jaurrieta, F, Lorente, L. A randomized trial of the effect of tubing changes on hub contamination and catheter sepsis during parenteral nutrition. Journal of Parenteral and Enteral Nutrition 1985;9:322–325.CrossRefGoogle ScholarPubMed
14.Tan, TQ, Musser, JM, Shulman, RJ, Mason, EO Jr, Mahoney, DH Jr, Kaplan, SL. Molecular epidemiology of coagulase-negative Staphylococcus blood isolates from neonates with persistent bacteremia and children with central venous catheter infections. J Infect Dis 1994;169:1393–1397.CrossRefGoogle ScholarPubMed
15.Matlow, A, Kitai, I, Pencharz, P, Kirpalani, H, Perman, M, Ford-Jones, EL. Retrograde contamination of TPN solutions: a potential cause of recurrent bacteremia in neonates. Presented at the 93rd General Meeting of the American Society for Microbiology; May 16-20, 1993:550. Abstract L-34.Google Scholar
16.Marcon, MJ, Powell, DA. Human infections due to Malassezia spp. Clin Microbiol Rev 1992;5:101–119.CrossRefGoogle ScholarPubMed
17.Robathan, G, Woodger, S, Merante, D. A prospective study evaluating the effect of extending total parenteral nutrition care changes to 72 hours. J Intraven Nurs 1995;18:84–87.Google Scholar