Forum topic

We change PIVs every 4 days.....

FYI...

Sharon

 We change PIVs every 96 hrs as long as they have a StatLock.  If they are PIVs without StatLock, they are good for 72 hrs.  Our policy for peds is to leave them in for an entire week.  We are looking at policy changes that would allow us to keep the PIV in longer for all patients, as it seems we are changing perfectly good IVs just because...  I believe that is becoming a standard nationwide?

What percentage actually last 4 days without a complicaiton? 

Old Maki study said about 20%

Kathy

The overriding point is that a set number of hours for a dwell time (e.g. 72 or 96 h) produces the same number and rates of complications as when the catheters are changed based on clinical indications (signs and symptoms of any complication). There is no longer a magic number of hours. They must be removed immediately at the very first sign or symptoms of any complication. Lynn

Believe it or not I have heard nurses say about a red, swollen, painful site that "it hasn't been in 96 hours yet. Can't we leave it?" So what we have done is added to our policy the verbage " clinically indicated" site changes. The end result we hope is going to be the nurses will be more aware of the indications (s/s of complications) to change the site regardless of the dwell time and still call the Vascular Access team/ IV therapy when sites have dwelled for 96 hours or more.With this policy change we are not bound by policy to change a site that has no s/s of complications. The IV Team at the hospital I work make a strong effort to assess every site over 96 hours anyway, but we believe the primary care nurse should have this infomation as well.

My hospital moved from 36 hour to 96 hour routine rotation and PRN a few years ago and are slowly moving to site assessment to be our guide to extend dwell time beyond 96 hours. Infection control nurse is requesting a response from my list serve just how many hospitals are following the INS guidelines in particular in CT. thanks

 I wrote my capstone on this subject (available by request) I would suggest researching the Cochrane report which is a compilation of all of the existing studies regarding extending dwell time. Dwell times with certain catheter types can be left in (clinically indicated) for up to 144hrs without increased rates of phlebitis and/or infection. Also, I would log onto www.ahd.com and search your facility for ALOS. This is a public report regarding Medicaid/Medicare. This would give you a good idea of the amount of money your facility could save by extending PIV rotation to CI. For example, hospital A ALOS is 5.6 days and Surgical floor is 7 days. By your existing policy, the PIV would be replaced 3x, instead of once or maybe twice

We recently changed our policy to follow the standards. We have support from our IC service. This means our nurses should assess their sites at the beginning of their tour and during their shift. The patients are also taught the s/s of when an IV may be going bad so they can report to us. Naturally we would then change the site. A majority of our patients are difficult to gain access so changing to meet the standards (there is no optimum dwell time) works for us. It also makes compliance easier.

We have changed to clinically indicated. Should there be dressing changes if the patient is here > 7 days?

Darla Silavent

We will be changing our policy soon to reflect changing PIV site when clinically indicated.  We plan to monitor PIV sites for awhile to ensure nurses are restarting PIVs when complications arise.

HI Alma: we switched to clinical indicated restarts ~ 2 years ago; clinical setting community. The average dwell time l time is ~ 2 days longer than when we routinely changed the site and phlebitis and infiltration rates are comparable.
Curious to know what evidence/data the ICP has to support her decision.

We are in the midst of exactly the same situation, only difference is that it is our ID docs who are not supporting this change. We currently change PIVs every 96 hours. Both of our ID docs worked previously in other institutions where the change to "clinically indicated" was made and they saw a huge rise in phlebitis and blood stream infections. Now, one wonders if they just started paying more attention because of the change and the numbers were actually no different, but I don't know the answer to that. We will not be changing our practice without their support.