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Time frame for spiking IV bags

Q: Do you have a regulation regarding how long an IV bag should be spiked before using it? I can’t seem to find any info on this. The IV has no added medications.

A: Actually a new download recently added to the Tools page [1], “Infection prevention requirements in ASCs: A Q&A on CMS compliance, common pitfalls, and best practices,” addresses that topic specifically.

This document references US Pharmacopeia (USP 2008), A General Chapter <797> Pharmaceutical Compounding – Sterile Preparations [2], which addresses time limits for spiking IV bags.

In short, the USP <797> recommendations call for IV bags to be spiked no more than one hour of administration. If the IV is not used within an hour of spiking the back, the IV and tubing should be discarded.

However, an APIC position paper [3] identifies this as controversial and unresolved issue. Since there is limited data on actual contamination in real practice and linking contamination with patient infection, APIC notes that recommending a definitive time frame is not feasible at this time. Therefore APIC recommends preparing IV bags “as close as possible to the time of administration,” but does not support advance preparation (i.e. the night before, or hours before) of immediate-use IV bags.

You can find more specific guidance on spiking IV bags by downloading the Q&A on the Tools page [1], or you can listen to the full webcast on CMS requirements for ASCs on-demand [4].