Optimal frequency of changing intravenous administration sets: Is it safe to prolong use beyond 72 hours?

OBJECTIVE: To determine the safety and cost-effectiveness of replacing the intravenous (IV) tubing sets in hospitalized patients at 4- to 7-day interv als instead of every 72 hours. DESIGN: Prospective, randomized study of infusion-related contamination ass ociated with changing TV tubing sets within 3 days versus within 4 to 7 day s of placement. SETTING: A tertiary university cancer center. PATIENTS AND METHODS: Cancer patients requiring IV infusion therapy were ra ndomized to have the IV tubing sets replaced within 3 days (280 patients) o r within 4 to 7 days of placement (232 patients). Demographic, microbiologi cal, and infusion-related data were collected for all participants. The mai n outcome measures were infusion- or catheter-related contamination or colo nization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BST), determined by quantitative culture of the infusate in association with blood cultures in febrile patients. RESULTS: The two groups were comparable in terms of patient and catheter ch aracteristics and the agents given through the IV tubing. Intent-to-treat a nalysis demonstrated a higher level of tubing colonization in the 4- to 7-d ay group versus the 3-day group (median, 145 vs 50 colony-forming units; P = .02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P = .09). However, w hen the 84 patients who received total parenteral nutrition, blood transfus ions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group. CONCLUSION: In patients at low risk for infection from infusion- or cathete r-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up t o 7 days may be safe, as well as cost-effective.