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

Abstract

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

Port Navigation: Let the Journey Begin

“…During continuous use, access needles should be changed every seven days, with caps and tubing changed every two days, except with TPN. When TPN is infused, tubing is changed every 24 hours because of the high glucose content and potential for bacterial growth (Mattlow et al, 1999).…”

Does Lipid Hang Time Make a Difference? Time Is of the Essence

“…Approximately 1 year later, a randomized control trial of 24-hour versus 72-hour IV tubing set changes in newborns receiving IVLE alone was conducted; a significant increase in mortality was observed when the IV administration set was changed at 72-hour intervals, compared with those changed at 24-hour intervals. 23 Unfortunately, given the earlier data regarding the differences in microbial growth potential and modes of infusing IVLEs as a separate infusion versus TNA, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] this outcome may have been predicted and therefore likely avoided. Table 1 reviews the salient points from critical references on microbial growth potential or infectious risk associated with IVLE therapy.…”

“…Canadian investigators compared the contamination rates between administration sets changed on a 24-or 72-hour basis in neonates receiving amino acid/glucose and lipid therapy. 23 IV lipid was delivered through a Buretrol (Travenol, Toronto, Canada) connected to an amino acid/glucose formulation with a "Y-shaped" adapter. Specimens drawn from the 72-hour administration set group yielded a higher contamination rate than those drawn from the 24-hour administration set group (2.32% versus 0.86%, p Ͻ .001, respectively).…”

“…The lipid incompatibility problem in pediatric PN formulas is magnified because IVLEs alone in this population are associated with significant morbidity and mortality. 4,8,17,18,23 Recent preliminary data on the compatibility of alternative lipid emulsions consisting of medium-chain triglycerides (MCTs) and soybean oil show them to be more stable than conventional pure soybean oil products in high osmolality 31 and low osmolality 32,33 TNAs for adults and those intended for the very young. 34 If confirmed, such products could eventually appear in the U.S. market and their use in TNA therapy in the very young may be a significant clinical advance, which could reduce infectious complications seen with IVLEs.…”

Prävention Gefäßkatheterassoziierter Infektionen

“…Dies gilt auch für Infusionen, die mittels Infusomaten verabreicht werden [192]. Für Infusionssysteme von Lipidlösungen hingegen werden bei 72-stündigen Wechselintervallen signifikant höhere mikrobielle Kontaminationsraten als bei 24-stündigen Wechselintervallen angegeben [193]. Totale parenterale Ernährungslö-sungen, sog.…”