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Hospitals often struggle with determining policies for the appropriate length of time to allow intravenous (IV) solutions to hang while being administered to a patient. USP <797> Pharmaceutical Compounding - Sterile Preparations deals with the time from preparation of the IV until the point of administration. Sterility time limits noted in USP <797> stop when administration of the IV is initiated.
There is no nationally accepted length of time hang time for most IV fluids. The Center for Disease Control and Prevention (CDC) Guidelines for the Prevention of Intravascular Catheter-Related Infections, 20111 provides some information concerning replacement of IV administration sets, but has no recommendations on the hang time for the majority of IV fluids. The Infusion Nursing Standards of Practice, Revised 2011 from the Infusion Nurses Society (INS) provides more detail, and uses the CDC recommendations as the basis for its standards. However, they also do not have specific guidance for hang time.
CDC recommendations are categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact. CDC has a standard method of listing recommendations. Their guidance regarding IV tubing changes (note: not hang time) include those in Category 1A, Category 1B, and unresolved issues.
The previous version of the CDC document (from 2002) included an appendix summarizing recommendations, including limited information on hang time of IV solutions. Though no longer included in the current document, it provides some guidance for policy development.
Tubing changes are listed in the CDC recommendations:
A hospital committee should review national recommendations (such as those from the CDC and INS) and procedures performed in the organization. The organization should address the tubing change guidance in the CDC recommendations, and determine if the IV hang time should match or differ from the hang time policy. Many organizations have different allowances for hang time, based on different levels of infection risk:
Many organizations change IVs started in emergency situations as soon as possible after the patient is stabilized, and change IVs prepared under the Immediate Use provision of USP <797> within 24 hours. Some organizations permit longer hang times for manufactured (plain and premixed) IVs than they do for pharmacy-prepared sterile preparations. Ensure that all practices are reviewed, and that infection prevention practices support the policy developed.
1. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011, CDC, available at www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
2. Infusion Nursing Standards of Practice, Revised 2011, Infusion Nurses Society, information available at www.ins1.org/i4a/ams/amsstore/category.cfm?category_id=7 3. Summary of Recommended Frequency of Replacement for Catheters, Dressings, Administration Sets, and Fluids, MMWR, 2002(Aug 16), available at www.cdc.gov/mmwr/review/mmwrhtml/mm5132a9.htm