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

  • Anne G. Matlow (a1) (a2) (a3) (a4), Ian Kitai (a1), Haresh Kirpalani (a5) (a3), Nicola H. Chapman (a6) (a7), Mary Corey (a6) (a7), Max Perlman (a5) (a3), Paul Pencharz (a1) (a3), Sue Jewell (a8), Cindy Phillips-Gordon (a8), Richard Summerbell (a9) and E. Lee Ford-Jones (a1) (a3)...
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.

Copyright
Corresponding author
Department of Pediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. D Maki , J Botticelli , M LeRoy , T Theikle . Prospective study of replacing administration sets for intravenous therapy at 48 vs 72-hour intervals. JAMA 1987;258:17771781.

2. J Band , D Maki . Safety of changing intravenous delivery systems at longer than 24 hour intervals. Ann Intern Med 1979;91:173178.

3. AE Buxton , AK Highsmith , JS Garner , CM West , WE Stamm , RE Dixon , et al. Contamination of intravenous fluid, effect of changing administration sets. Ann Intern Med 1979;90:764768.

4. H Gorbea , D Snydman , A Delaney , J Stockman , W Martin . Intravenous tubing with burettes can be safely changed at 48 hour intervals. JAMA 1984;251:21122115.

6. ML Pearson , the Hospital Infection Control Practices Advisory Committee. Guidelines for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:435473.

8. SL Zeger , KY Liang . Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121130.

9. DG Maki , FS Rhame , DC Mackel , JV Bennett . Nationwide epidemic of septicemia caused by contaminated intravenous products. Am J Med 1976;60:471485.

10. J Freeman , D Goldmann , N Smith , D Sidebottom , M Epstein , R Piatt . Association of intravenous lipid emulsion and coagulase negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 1990;323:301308.

13. A Sitges-Serra , J Linares , J Perez , F Jaurrieta , L Lorente . 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;9:322325.

14. TQ Tan , JM Musser , RJ Shulman , EO Mason Jr, DH Mahoney Jr, SL Kaplan . Molecular epidemiology of coagulase-negative Staphylococcus blood isolates from neonates with persistent bacteremia and children with central venous catheter infections. J Infect Dis 1994;169:13931397.

16. MJ Marcon , DA Powell . Human infections due to Malassezia spp. Clin Microbiol Rev 1992;5:101119.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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