Use aseptic technique when changing tubing and bags or bottles. The tubing systems have a spike on one end. Remove the protective cover from the bag or bottle and do not contaminate the insertion site. Remove the protective cover from the spiked end of the tubing and inserted into the bag or bottle. Setting up the system can be done in the medication room or the patient’s bedside. Most medication rooms have enough room to lay out the equipment and control the sterile ends of the bags, bottles and tubes.
Use only bags or bottles that are sealed and within the expiration date. If the contents of the bag or bottle of IV fluid is cloudy or not the color it is supposed to be, do not use it. The addition of medication or parenteral nutrition may change the color. These additions should be noted on the bag by the pharmacy or by the nurse who added the substance.
Microdrip systems deliver 60 drops/mL. It is used when infusing small volumes. It is commonly used with infants and pediatrics. Microdrips reduce the risk of clotting in the line because of slow infusion rate. It also provides fluid overload safety by restricting the maximum amount infused. Microdrip systems may have a drip chamber that contains up to 100 mL and is clamped off from the liter bag of fluids. This is an additional safety to prevent fluid overload in at risk patients.
Macrodrip systems deliver 10, 15, or 20 drops/mL. 20 drops/mL is the most common type. Most facilities use a standard macrodrop size to prevent potential errors. Macrodrips are used in most adults for large quantity infusion and for rapid infusion. Most IV bags and some glass bottles have a built-in air vent to prevent a vacuum. If a glass bottle does not have a vent built in, vented tubing can be used. Most facilities standardize their bags or bottles to avoid problems. Most facilities use bags.
Filters are usually built in lines used for blood or parenteral nutrition. There are filters that can be added between the tubing and the IV bag. Most facilities standardize to avoid problems. If you need a special filter for blood infusion, the blood bank will provide that add in filter or special tubing with built-in filter.
Most infusion pumps require special tubing. This will be standardized by the facility.
Secondary administration tubing is used to piggyback IV medication bags to infusion tubing. The medication bag should always be hung higher than the IV liter bag.
There is specially coated tubing that prevents the leaching of polyvinyl chlorine from the tubing. This should be used for infusion for nitroglycerin, paclitaxel and cyclosporine.
Tubing add-in devices are available. They include:
- Single and multilumen extension sets
- Extension loops
- Needleless connectors
- Inline filters
- Manual flow-control devices
Minimize tubing manipulation and multiple components in the tubing to reduce the chances of contamination.
The frequency of changing the IV administration sets is specific to facilities. The following are evidence-based recommendation changing schedules.1 Primary and secondary continuous tubing should be changed no more frequently than every 96 hours and at least every 7 days. Tubing used for parenteral nutrition should be changed every 24 hours. Tubing used for blood must be changed every 4 hours. Tubing for fat emulsion infusion must be changed every 12 hours.
The tubing system must be labeled when it is hung with the date, the time it was opened and the initials of the person applying the tubing. This allows everyone to identify when the tubing needs to be changed.