Infusion Line Preparation

Clinical Objective

Establish intravenous infusion systems using strict aseptic technique, with fluid preparation timed appropriately relative to surgical use, to prevent intravascular introduction of organisms during the perioperative period. Shared, pre-spiked, or reused fluid systems carry significant contamination risk. Each patient must have a dedicated, freshly prepared infusion system with all access points protected.

Why This Matters

IV-related infections — though less common than incisional SSIs — can be catastrophic, particularly in immunocompromised or critically ill surgical patients. The same pathogens responsible for SSIs can enter via improperly prepared fluid lines, syringes, or multi-use ports. Standardizing line preparation is a high-yield, low-cost intervention.

Critical Control Points

• Prepare infusion lines immediately before use — not hours in advance

• Never share a spiked or open fluid bag between patients

• Never reuse a syringe, even between draws from the same bag

• Disinfect all injection ports before access using friction and an alcohol-based swab

• Label all prepared syringes with drug, concentration, date, and time

Infusion Line Preparation Checklist

Complete all items for each patient before connecting any IV infusion. Document deviations and notify the anesthetist.

Case Fluid Record

Step-by-Step Protocol

1. 1

   Prepare fluids at the time of use

   • ·Spike fluid bags immediately before priming the line — do not pre-spike
   • ·Inspect bag for clarity, expiration, and absence of particulate matter
   • ·Prime the line and remove all air before connecting to the patient
2. 2

   Use patient-dedicated fluid systems

   • ·Each patient receives a dedicated fluid bag and line — never carry over between patients
   • ·Do not leave spiked bags open for use in a subsequent case even if unused
3. 3

   Maintain injection port asepsis

   • ·Swab each injection port with 70% isopropyl alcohol and allow to dry before access
   • ·Use a new sterile syringe for every drug draw or injection
   • ·Do not recap and reuse syringes
4. 4

   Label all prepared medications and infusions

   • ·Label syringes with drug name, concentration, patient ID, preparer initials, date, and time
   • ·Discard any unlabeled or expired preparation
   • ·Never administer a preparation drawn from a syringe that has been set down out of view
5. 5

   Protect line integrity during case

   • ·Keep stopcocks capped when not in use
   • ·Replace injection caps if contamination is suspected
   • ·Minimize the number of T-ports, stopcocks, and extension sets — each connection is a risk point

Key Pitfalls

• Pre-spiking multiple bags in advance to save time — a common but dangerous shortcut

• Reusing syringes between drug draws, even from the same vial

• Leaving stopcocks open and uncapped between uses

• Failing to label prepared syringes, leading to drug administration errors and traceability gaps

• Carrying a partially used fluid bag to the next surgical patient