Changing i.v. administration sets: is 48 versus 24 hours safe for neutropenic patients with cancer?

To examine the effects of changing i.v. administration sets at 48 versus 24 hours on the incidence of infusion-related septicemia in neutropenic patients with cancer.

Prospective, randomized clinical trial with repeated measures.

Large urban cancer center.

50 adult inpatients with a primary diagnosis of hematologic malignancy, breast cancer, or testicular cancer or who were receiving a stem cell transplant.

Subjects were assigned randomly to have their i.v. sets changed every 48 or 24 hours. Subjects continued in the study for a maximum of five measurements, until they were no longer neutropenic, or until transferred or discharged from the hospital.

Rates of infusate colonization, microorganisms identified, incidence of infusion-related septicemia.

Colonized infusate was detected in 18 (5%) of 413 i.v. sets; 9 (5%) of 177 sets were changed at 48 hours, and 9 (4%) of 236 sets were changed at 24 hours (p > 0.05). A trend toward increased colonization of i.v. sets used to administer parenteral nutrition (19%) and, to a lesser extent, electrolytes (9%) was identified in the 48-hour group. Coagulase-negative staphylococci were the most frequently isolated microorganisms in the i.v. infusate. Similar organisms were isolated from blood cultures and administration sets, however, no subject had identical organisms isolated from both i.v. infusate and blood cultures. No subject with colonized infusate developed infusion-related septicemia.

No difference existed in the incidence of colonization or infusion-related septicemia between subjects whose i.v. administration sets were changed at 48 versus 24 hours.

Changing i.v. administration sets every 48 hours is recommended. Exceptions to this include i.v. administration sets used to administer blood products and total parenteral nutrition.