Hi everyone, I would like to pose a question.
How often are your peripheral IV catheters changed?
Every 3 days, every 4 days or left until patient is discharged or site complications occur.
Thanks everyone.
Hi everyone, I would like to pose a question.
How often are your peripheral IV catheters changed?
Every 3 days, every 4 days or left until patient is discharged or site complications occur.
Thanks everyone.
Every 96 hours unless pediatric - then it remains in as long as there are no complications.
Wendy Erickson RN
Eau Claire WI
Wendy, can you let us know the rationale for not applying the standard of changing all PIVs based on clinical indication? This practice has been used in peds for a very long time, but we have changed PIVs based on the calendar or clock - 72 to 96 hours. There have been no reports of a higher rate of any type of infection from PIVs in peds with the policy of change based on clinical indications. Just trying to understand the thought processes used for these decisions. Thanks 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 thought CDC 2011 still said that PIVs in adults did not need site change for frequently than every 72-96 hours, but the issue of replacing catheters in adults only when clinically indicated had no new recommendation. Despite my efforts to follow INS' new guideline to replace adult PIV only when clinically indicated, my facility has chosen to stick with the CDC guidelines that still list a time range. Frustrating.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Sorry, I never got back to this until now. Our reasoning is that when I approached our Infectious Disease physician about implementing the change to "when clinically indicated", he felt that there was not enough research to support this change and would not approve it.
Wendy Erickson RN
Eau Claire WI
Strong evidence from randomized trials show that changing a PIV based on clinical indications produces outcomes equivalent to changing based on a specific number of hours. INS Standards (which are not guidelines) accepted this evidence and changed the standard in 2011. CDC did not completely accept this evidence for adults in 2011. However for many, many years CDC has recommended the practice of changing a PIV in pediatrics based on clinical indication rather than a number of hours. It does not seem reasonable to me to apply this standard only to peds and not adults. 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 just received a request to change out a PICC because it has been inplace for about one year. This is a Hem/Onc pt. It is working well and no sign of infection. Is time that it has been in place reason enough? Is pt at high risk of infection if left in place vx placing a new one? If it should be replaced could I just do an exchange or move to new site?
Debra Rivie
Long Beach Memorial Medical Center
Long Beach, CA
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
Patient with a DVT in upper arm, any reason labs shouldn't be drawn for the same arm?
Debra Rivie
Long Beach Memorial Medical Center
Long Beach, CA
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
Posted last two questions as eply in error!
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
Per the Infusion Nurses Society 2011 Infusion Nursing Standards of Practice, practice criteria includes the following
(pg S57)
"The nurse should consider replacement of the short peripheral catheter when clinically indicated and when the infusion treatment does not include peripheral parenteral nutrition. The decision to replace the short perihperal catheter should be based on assessment of the patient's condition; access site; skin and vein integrity; length and type of prescribed therapy; venue of care; integrity and patency of VAD; dressing; and stabilization."
In other words the peripheral IV can remain in as long as it is complication free, which per INS would be site grade 0, no redness, swelling, drainage, etc. I have changed our home care policy to reflect this as well. We don't have that many peripheral IVs and also not for an extended period of time. The catheter still remains a foreign body. The innermost layer of the vein where the catheter lays is one cell thick, so you can see why all the criteria per INS are important to be considered. IT is also critical that a line is placed with the utmost aseptic technique, cleansing a large area well with chlorhexidine, not touching it after the cleanse, let CHG dry well, insert catheter atraumatically, dress and secure well so there is not pistoning, and of course maintain appropriate flushing protocols.
I don't know that I would really like to see a peripheral IV over a week old, personally!
Karen Charnigo, MSN, RN, CRNI
We use Lippincott for policy and I was so happy to see we don't have to change according to the calender.