A randomized trial of 72- versus 24-hour intravenous tubing set changes in newborns receiving lipid therapy.
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.


METHODS
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.


METHODS
A 35-bed, teaching, referral, neonatal intensive-care unit (NICU).


METHODS
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 the 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 significantly associated with lipid set contaminations (odds ratio, 2.69; P=.0013). The rate of blood cultures ordered was higher in the 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.


CONCLUSIONS
Microbial contamination of infusion sets is significantly more frequent with 72- than with 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.
Matlow
A G
AG
Department of Pediatrics, Hospital for Sick Children, and University of Toronto, Ontario, Canada.
Kitai
I
I
Kirpalani
H
H
Chapman
N H
NH
Corey
M
M
Perlman
M
M
Pencharz
P
P
Jewell
S
S
Phillips-Gordon
C
C
Summerbell
R
R
Ford-Jones
E L
EL
D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D001419:Bacteria / Q000302:isolation & purification; D001769:Blood / Q000382:microbiology; D003470:Culture Media; D004340:Drug Contamination / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005658:Fungi / Q000302:isolation & purification; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000295:instrumentation*; D007363:Intensive Care Units, Neonatal; D010288:Parenteral Nutrition / Q000295:instrumentation*; D013997:Time Factors
D003470:Culture Media; D005217:Fat Emulsions, Intravenous