PPN Tubing Replacement Frequency
For Peripheral Parenteral Nutrition (PPN) tubing, replace administration sets every 24 hours when lipid-containing solutions are infused, and no more frequently than every 72 hours for non-lipid containing solutions. 1
Lipid-Containing PPN Solutions
Replace tubing within 24 hours of initiating infusion when administering lipid emulsions or lipid-containing parenteral nutrition (3-in-1 solutions), as these create a medium that significantly promotes microbial growth and increases catheter-related bloodstream infection (CRBSI) risk 1, 2
The CDC considers parenteral nutrition an independent risk factor for CRBSI and specifically recommends 24-hour replacement for lipid-containing solutions (Category IA recommendation) 1, 2
There is no evidence supporting safe extension of lipid-containing administration sets beyond 24 hours, and this is universally accepted as best practice 1, 2
For home parenteral nutrition patients on cyclic regimens, infusion sets are typically replaced every 24 hours as a natural consequence of the cycling schedule 1
Non-Lipid Containing PPN Solutions
Replace administration sets no more frequently than every 72 hours for crystalloid or non-lipid containing parenteral nutrition solutions 1, 2, 3, 4
Evidence supports that administration sets can be safely left in place for up to 96 hours without increasing infection risk in patients not receiving lipids, blood, or blood products 1, 3, 4, 5
The CDC provides a Category IA recommendation (strongest evidence level) for 72-hour replacement intervals, with data showing infusate colonization rates remain extremely low (0.4%) even when fluids are used for up to 185 hours 2
Critical Distinctions and Pitfalls
Never extend lipid-containing infusion sets beyond 24 hours, regardless of how well-tolerated standard sets may be at 72 hours—the infection risk profile is fundamentally different 1, 2
A randomized trial specifically involving PN infusion found that changing tubing every 4 days versus every 2 days did not impact hub contamination or CRBSI rates, but this applied only to non-lipid solutions 1
One study demonstrated higher tubing colonization when sets were changed every 4-7 days versus every 3 days; however, when patients receiving total parenteral nutrition were excluded, colonization rates were comparable (0.4% vs 0.5%) with no BSIs in either group 6
A Cochrane systematic review found no evidence that CRBSI rates were affected by frequent changes of non-lipid containing tubing, though some evidence suggested mortality increased in neonatal populations with infrequent giving set replacement 1, 4
Additional Considerations for PPN
Replace tubing used to administer blood products within 24 hours of initiating the infusion 1, 2
Complete infusions of blood products within 4 hours of hanging 1, 2
Cyclic infusion of PPN (12-hour infusions with cannula removal between cycles) significantly reduces the incidence of infusion phlebitis compared to continuous infusion 7
Replace peripheral venous catheters and rotate sites no more frequently than every 72-96 hours in adults to prevent phlebitis 1