I know that USP 797 does not cover BUD or expiration date once the CSP is starting infusing on the patient. I know most hospital policies is 24 hours once a bag is hung. I was wondering if anyone knew where this information came from or if they are any guidelines or insight relating to how long CSPs or IV fluids can hang for?
A different USP reference may offer some guidance. The General Chapter <1191> in the United States Pharmacopeia entitled Stability Considerations in Dispensing Practice states in part the following:
“Combining parenteral products necessitates special care, particularly in the case of intravenous solutions, primarily because of the route of administration. This area of practice demands the utmost in care, aseptic technique, judgment, and diligence. Because of potential unobservable problems with respect to sterility and chemical stability, all extemporaneous parenteral preparations should be used within 24 hours unless data are available to support longer storage.”
In addition to the reference that Harry pointed to (nice find!), the CDC has practice guidelines titled Guidelines for the Prevention of Intravascular Catheter-Related Infections that also addresses the 24 hour timeframe. A copy is attached to this post
The CDC document referenced contains recommendations for lipid-based solutions and blood. It does not take a stance on any other parenteral fluids in terms of beyond use dating after a solution is hung. To date, that has historically been left to the discretion of the individual facility.
Assuming chemical stability is published, we give our fluids a 72 hour hang time. This allows the RN to change both the line and the fluid at once (Assuming there is solution still in the bag).
Can someone shed some light on how this applies to ambulatory infusion pumps? We commonly dispense 5FU CADD cassettes with 48 hour or longer drug supplies. Thanks.
