We are in the process of looking at changing our policy for peripheral IV site change from 96 hours to changing when clinically indicated. I am aware that INS supports this but the CDC still states the 96 hours in their guidelines. For those of you that have changed your policy, have you included anything about changing the peripheral IV site dressing or cleaning the skin with chloraprep after a certain number of days that the peripheral IV has been in place or does the same dressing remain on for the entire time that the peripheral IV is in place? Thanks for your help in advance.
I would apply the same rules - change if it is dirty, wet, or nonocclusive. But would otherwise allow it to remain on for up to 7 days like we do with CVAD dressings. What is your average length of stay for hospitalized patients? You may find that this is not an issue for most patients because they are being discharged so quickly. For those that are inpatient for extended periods, I don't think we have any other answers yet. The good thing is that the same researchers in Australia who led the way on this change issue is continuing to do a lot more research on peripheral site management. So we may be seeing more come from them in the future. Lynn
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
So you think its "safe" to use this policy now. Are there a statements from INS or any other organisations???
Nurse specialist ICU/ANE/PICC.
Dep. of Neurosurgery
Umea University Hospital/SWEDEN
If you are referring to changing a peripheral catheter when it is clinically indicated rather than at a prescribed number of hours, yes I think it is the most appropriate method. Lynn
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 have been trying to win the battle on this topic for years, changing an IV site based on clinical assessment rather than fixed time, but am squashed every time. I presented evidence from the large Australia study, but said that there has to be more multi-location studies elsewhere. I have done internal longevity studies, and added that INS has released a position paper indicating this, but the infection preventionists will not budge without full endorsement from the CDC. This is frustrating because the CDC continues to drag their feet on the subject, while allowing clinical assessment to dictate changing PIVs in pediatrics. I would hope that there be a large study in the States to show changing PIVs based on clinincal assessment on adults is safe and warrented in todays changing healthcare setting.
Bradford A. Dungan, RN, BSN, PHRN, VA-BC
[email protected]
Bradford A. Dungan
I don't know of anything going on here in the USA, but I know that the Australian research group is planning many studies on PIV complications, etc. CDC has no specific schedule for revising their guidelines, so you could be waiting a long time. Last time was 2002 to 2011. Lynn
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'm curious as to the liability of extending the dwell time of a PIV beyond the manufacturers approved claim. I have been provided a Smiths Medical IV resource guide. One page discusses peripheral IV catheter site rotation. The author describes the history of site rotation and includes the 2011 INS statement. With that said, the next sentence is "to date, no manufacturer possesses an approved claim of 96-hour or greater indwelling for their peripheral IV catheters".
Thoughts??
FDA Guidance documents written for manufacturers does not include recommendations for dwell time for any vascular access device of any kind. So manufacturers do not make such claims. The new midline devices are now marketing with the "29 day" claim, but that does not indicate any claim about dwell time. These FDA guidance documents requires manufacturers to determine if they are making an application to the FDA for a short term device (less than 30 days) or a long term device (greater than 30 days). Optimal dwell time for any type of VAD depends upon clinical research and the guidelines from CDC and standards from INS. INS already supports changing peripheral catheters when clinically indicated in the 2011 SOP. CDC in 2011 stated this was an unresolved issue. Manufacturer information regarding catheter dwell time is based on CDC and INS documents and not their actual product claims. So manufacturers instructions for use would not be an issue in any legal case involving a question about catheter dwell time as this would defer to INS and CDC. Lynn
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
This may sound like a ridiculous question but what % of PIV's actually last beyond the 96 hour time period?
I know the old Maki paper 2001 1,054 PIV's lost almost 50% by day two and another 20% on top of that by day five.
What percentage is left indwelling after 96 hours? I would do an internal study to find that one out? It would be an interesting number to see what % of pateints we are actually referrring to?
Kathy Kokotis