Our vascular access team has been recently called to replace ultrasound guided PIV's daily for a patient receiving chemotherapy. The PIV's that we are being asked to replace were placed using ultrasound, continue to flush easily, no redness, pain, swelling or leaking. I am unable to find documentation that supports daily replacement of ultrasound placed PIV's that are without complications for patients receiving chemotherapy.
Does it yield a blood return easily when aspriated? Blood that is the color and consistency of whole blood? If yes, plus no resistance to flush and total absence of any other sign or symptoms including complaints of pain or tenderness, there should be no reason to remove it daily. This is probably coming from the ONS statements that catheters older than 24 hours have a greater risk of infiltration/extravasation. You should also consider the exact site (joints are very bad), the catheter size and length - should be very small but long - and if the meds being given are vesicants, irritants, both or neither. Also think about how long this entire treatment will be needed and whether the patient needs a CVAD. ONS also says for peripheral vesicants, you need a blood return before, every 5 mins during (or every 2-5 mL is by push) and after the infusion, do not use a pump for vesicants and periphera infusion should not be longer than 30 min.
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