“ Since 2013, shortages of nonadditive dextrose and normal saline IV solutions have been occurring intermittently and have created uncertain supply and demand issues for hospitals and other healthcare settings,” explains Therese B. Mianecki, Ph.D., RN. “Due to these shortages, many healthcare institutions have had to revise policy and procedures related to how IV solution administration is managed, resulting in maximum hang times of nonadditive IVs being increased from 24 hours to 96 hours. Although previous studies have examined patient safety related to lengthening hang times of IV administration, few have examined the relationship between extending hang times beyond 24 hours and the incidence of central line-associated bloodstream infections (CLABSIs).”
These infections, Dr. Mianecki adds, can result in increased morbidity, mortality, and associated costs for patients diagnosed with CLABSIs and have been estimated to cost more than $50,000 per patient and more than $2 billion annually.
The demand for IV solutions is estimated to be in the hundreds or thousands per day, Dr. Mianecki says, depending on patient census and acuity, and it is critical that IV solutions be available to provide for patients’ fluid needs. “At the same time, patient safety is always at the forefront of daily decisions made by healthcare professionals (HCPs), so along with providing for the fluid needs of patients, HCPs want to be certain that care is not being compromised,” she says.
Comparison of CLABSIs Between Groups Not Significant
For a paper published in the Journal of Infusion Nursing, Dr. Mianecki and colleague Edward L. Peterson, Ph.D., investigated whether longer non-additive IV hang times escalate patient infection rate. They conducted a retrospective chart review; data were abstracted from the medical records of 2,967 inpatients admitted during a 5-month period to an 887-bed, quaternary care hospital in the Midwest. The data included length of stay, CLABSI incidence, admitting diagnosis, gender, IV type, and total IV hang time in hours, patient care unit, and patient age at admittance. The researchers compared the incidence of CLABSIs before (comparison) and after (intervention) lengthening the duration of IV hang times up to 96 hours.
The study’s findings indicate that increased hang time did not contribute to higher infection rates. “Comparison of the incidence of CLABSIs between the intervention and comparison groups was not significant,” Dr. Mianecki says. “Therefore, this outcome adds to evidence that IV hang time can be extended without major concerns about the increased incidence of CLABSIs.” The researchers found five (0.27%) CLABSIs in the intervention group, while the comparison group experienced two (0.20%) CLABSIs. Statistical testing was not performed due to the low number of infections within the two groups (Table).
Findings May Be Generalized to Similar Settings
“Based on these findings, the current standard of care could be changed to reflect the safety of hanging nonadditive IV solutions for up to 96 hours in adult patients,” Dr. Mianecki concludes. “Lengthening hang times of IV solutions would also synchronize with the recommended hang times and replacement of IV tubing administration sets and minimize the risk of potential contamination that can occur when IV delivery systems are unnecessarily broken to change solutions.”
Furthermore, Dr. Mianecki adds, these findings may be generalized to other similar health center populations and provide evidence to support policy changes for IV hang time durations. “Clinically, this research provides supportive evidence for healthcare administrators and HCPs who are concerned about the safety of extending IV hang times and are seeking guidance to support policy changes,” she says. “HCPs who work in infusion centers can use these findings to help make policy changes for similar adult patient populations.”
Drs. Mianecki and Peterson would like to see future research focused on bloodstream infections and adverse events related to short peripheral IV catheters (PIVs). “Since PIVs are the most commonly used IV catheters—with millions of PIVs inserted each year to deliver blood, fluids, and medications—additional research in this area may help decrease the incidence of related patient complications,” says Dr. Mianecki.