(1218) An Interrupted Time Series of Two Different Frequencies for Intravenous Intermittent Tubing Duration

Introduction: Intravenous (IV) lines provide systemic access to deliver time sensitive fluid and pharmaceuticals to hospitalized patients. While providing valuable access for interventions, the IV is also a portal for infection. The frequency of primary and intermittent IV tubing changes/expiration has evolved over time and is just one aspect of tubing maintenance care. While evidence exists to support the changing of
primary IV sets between 96 hours and 7 days, a paucity of evidence exists on change frequency of intermittent tubing. Published vascular access standards, based on expert opinion, recommend intermitting tubing change every 24 hours. The purpose of this study was to compare the practice of changing intermittent IV tubing at 96 hours versus 24 hours. Hypothesis: There is no difference in central line associated blood stream infection (CLABSI) between the 24- and 96-hour intermittent IV tubing change.

Methods: A quasi-experimental interrupted time series with 8 months per time-period was conducted. Three ICUs (neuroscience, cardiothoracic, and medical) served as their own control across the periods. The tubing change cadence designed was time-period 1: 96 hours; period 2: 24 hours; period 3: 96 hours based on previous practice, practice change to INS standards, and study period return to 96 hours. The outcome variable was unit CLABSI rates.

Results: CLABSI rates comparison in each unit across the time periods showed no difference across the 3 time periods for all units (p>0.05) based on segmented regression analysis. When comparing CLABSI rates in the study units compared to the non-study units, there was no difference in rates across the time periods based on segmented regression analysis.

Conclusions: This study adds to the body of evidence that supports decreasing frequency of intermittent IV tubing changes by extending duration of use to 96 hours. Nursing staff also reported increased vigilance in maintaining sterility of the IV tubing including ensuring no contamination, disinfection caps in place, and proper connecting/disconnecting practices. With no difference in CLABSI rates and a described decrease in nursing work burden and associated decreased cost with fewer tubing usage, the practice change to 96-hour intermittent IV tubing change is recommended.