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Alma Kooistra
96 hour site changes

OK......this is my first effort at the web   may need to be patient with me........

 We're looking at switching to 96 hour peripheral IV site changes, and I think it may be a bit premature.   I don't know that anyone has recently researched  phlebitis rates here, and I want to see that done first.  

What I'm wondering is, what were the % phlebitis rates that allowed us to  have 72 hour site changes, and where is that written up?   I'll need that info asap to take to quality risk in order to temporarily put the brakes on their plan to change policy.   The people who handed this mandate down are not those with their finger in the IV therapy pot.......they're looking at cost savings only, and I'd like to give evidence of our phlebitis rates (good or bad) before we move foreward.   I'll look that up, but I need one of you to let me know where the benchmarks are.

Thanks much!!!

Alma K.

1-This is pretty well

1-This is pretty well studied. the change to 96 hour site changes is recommended by the CDC.

AACN practise alert for preventing CRBSI states to change PIV's every 96 hours. Also stated is that studies have shown that there is no substantial increase in phlebitis from iv site changes at 96 hours compared to 72.

See study AJIC: American Journal of Infection Control. 26(1):66-70, February 1998.
Lai, Kwan Kew DMD, MD

I recall but don't know from where ....INS newsletter? that Lynn responded to a question re: phlebitis that INS had removed "benchmark for phlebitis" due to lack of research. Sorry, Lynn, if I quote you wrongly.

vera lynne philson
We switched from 72h changes
We switched from 72h changes to 96h when CDC guidelines changed & saw a significant increase in our phlebitis rate. We recently switched back to 72h changes, because of this. Vera
In our facility since IV

In our facility since IV therapy has been taken out of the picture for performing and monitoring site rotations, it just doesn't get done.  Sites fall out first.  It's disgusting.  No one is monitoring anything.  Sad state of affairs.  I wish more patients would complain.   



Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA


We also switched when the

We also switched when the CDC recommended the change.  We have seen no increase in phlebitis rates.  We were all very surprised by this as we were kicking and screaming about changing.

Honestly, most pt.s do not make it to the 96 hour mark, they needed restared prior for various reasons.

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

I have to laugh - don't get

I have to laugh - don't get offended but at least 70% of all the IV's you place will not make it to 96 hours and that is based on a large prospective, randomized study done by Dennis Maki in 1989.  Patient's have less vasculature now and are sicker. 

 I would switch to 96 hours easily but than I would wonder why a patient who needed a peripheral IV for 96 hours is not considered a PICC candidate.  Phlebitis is not an issue with PICC lines and I have to wonder would it not be better to put those hyperosmotic and acidic drugs in a central line versus a peripheral line

Bottom line how many drugs are going thru that peripheral line that is supposed to last 96 hours and what type of drugs are they, and where does that peripheral IV reside (in the hand?).  That is how to reduce phlebitis

Kathy Kokotis

Bard Access Systems

Darlene Kaminski
We also switched to 96
We also switched to 96 hours. Before that our IV's were changed every 72 hours.   Prior to the switch, in accordance with our infection control nurses we conducted a point prevelance study on phlebitis. In one day every IV site was assessed. Our phlebitis rate that day was 10 %.  After the change, we conducted another.  Any guesses?  14% phlebitis rate.  Hmmmm?   Has our policy changed?.......No
We just recently added a

We just recently added a antireflux device on our peripheral IV and increased our IV's lasting 72hours from 20% to 52%.  We are trying to obtain iv protocols from different hospitals that are doing 96 hour iv sites and IV tubings to extend our study to see if this is very practical.  My hopes is that it will be.  Most of the IV's at 72 hours had no site issues.  By the way we reduced our phlebitis rates by adding the antireflux device to our peripheral lines.  Any one willing to share their current policy on tubings and IV's with me.




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