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

Published online by Cambridge University Press:  02 January 2015

Anne G. Matlow ,
Ian Kitai ,
Haresh Kirpalani ,
Nicola H. Chapman ,
Mary Corey ,
Max Perlman ,
Paul Pencharz ,
Sue Jewell ,
Cindy Phillips-Gordon  and
Richard Summerbell
...Show all authors
Anne G. Matlow*
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Ian Kitai
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
Haresh Kirpalani
Affiliation:
Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Nicola H. Chapman
Affiliation:
Department of Biostatistics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Mary Corey
Affiliation:
Department of Biostatistics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Max Perlman
Affiliation:
Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Paul Pencharz
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Sue Jewell
Affiliation:
Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
Cindy Phillips-Gordon
Affiliation:
Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
Richard Summerbell
Affiliation:
Ministry of Health Laboratory Services Branch, Toronto, Ontario, Canada
E. Lee Ford-Jones
Affiliation:
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
*
Department of Pediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 7 , July 1999 , pp. 487 - 493
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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