We have had an increase in PIV BSI's and are looking at ways to correct that. One area is "idle IV's". That is an IV that has had nothing med-wise given, just the Q 8 hour flushes. We are trying to discern what constitutes idle and if this is an area to focus on. We think that 24 hours of non use possibly would need the IV removed, per a nurse driven protocol. Does anyone do anything like this and if so what are the criteria?
24 hours of nonuse for a PIVC is the criteria in the INS SOP VAD Removal.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I cant help but thinking.......what if we take that IV out today because its been in 24 hours and not used then.....next day their heart rate drops /accelerates ( anything happens) then they need an IV and now they have none and staff is running around trying to get an IV.
I notice it says to remove the short peripheral catheter if it is no longer included in the plan of care or has not been used for 24 hours or more.
when they say "plan of care" what is there criteria for that? actively being used for adminstration of prescribed therapy? What about the pts who are on cardiac telemetry, seizures,....anything where something unexpected could happen and you always want to maintain a patent iv for emergent /urgent situations?
Thanks in advance for your input! Gina
Gina Ward R.N., VA-BC
The chances of an idle PIV not functioning when and if it is needed in an emergency are great. In a true emergency, there should be the availability of IO and in an urgent situation, there is US to locate a vein. Plan of care means an active prescription of any IV fluids or meds.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks for clarification on plan of care.
The options you mentioned IO/ US are not so readily available in our facility. IO is only done in the ER on a very rare ocassion and I ( The Infusion Team) has the only ultrasound and skills to start an US guided IV. We may be in doing a procedure and not readily available .
I would like to explore IO more and see why we are not utilizing that more. We also have a goal in the near future to train some key nurses in ultrasound guided IV insertions.
Thanks again for your help! Gina
Gina Ward R.N., VA-BC
Thanks for responding, sometimes we find patients that have 2-3 saline locks and no infusing fluids or meds. Or an infusing site and 2 other non-needed sites. We are looking to come up with a nurse driven protocol for removal of those idle IV's. The ordering MD will be in on the discussion with the protocol. Does any facility do that? Our Medics are also the only I/O inserters and, per their scope of practice, cannot come out of the ER.
We usually always keep atleast one IV in the pts.
but.... when I am rounding if a pt has multiple IVS and it is not indicated, or......they are even keeping the peripheral after I placed a PICC or Midline then I remove that peripheral or peripherals. I am sure to review the plan of care and medication record to be sure it is not indicated but if it is not we are removing them.
But, we are not removing the one and only IV because it is not being used. We have to work toward that or explore it more.
Gina Ward R.N., VA-BC
Recently I have been reading a lot about practice at the top of one's license, a level most RNs have not reached yet. I maintain that this is a decision about PIV removal can and should be made by knowledgeable infusion/VA nurses. This is one example of practicing at the top of our nursing license in our specialty practice. Not advance practice RN license but RN license. There are numerous other decisions that should be within nursing scope of practice also. There are significant barriers to reaching practice at the top of our license but we need to work toward removing them.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861