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Alma Kooistra
Peripheral IV Site Changes

OK.....I'm whining a little.

We are 11 months post publication of the INS Standards and I'm still working on policy re routine peripheral IV site changes.

The new Standards say: consider replacement of peripheral IV site when clinically indicated, based on patient condition, access site, etc, etc.

The CDC guidlines address this time frame by saying it is an unresolved issue.

In my facility we still require a peripheral IV site rotation of 96 hours.  I would like to change our policy to reflect what the Standards have to say.

This change has been held hostage by our infection control nurse.  Not by the physician head of infection control....he says OK to follow the Standards.....but this has made it to the infection control nurse's desk and she will not agree to the change and no one seems willing to bypass her blessing.

I have addressed the difference between Standards and Guidelines (outlined nicely by Lynn Hadaway on this forum) but that has not made any difference.

Interestingly enough, they have asked me to poll the list serve to see what 'others are doing'.

So.......please respond.

Do you have a timed routine requirement for peripheral IV site changes?

Thank you.....

Alma Kooistra CRNI

We change PIVs every 4

We change PIVs every 4 days.....



 We have changed to reflect

 We have changed to reflect the new INS Standards, change IV sites when clinically indicated. As remarked on above, this could be any time after the initial insertion, 2 hours up to whenever, just when it is clinically indicated. We have added language on EPIC to reflect the reason why it was removed, i.e. phlebitis, pain, dislodgement, etc.

 We change PIVs every 96 hrs

 We change PIVs every 96 hrs as long as they have a StatLock.  If they are PIVs without StatLock, they are good for 72 hrs.  Our policy for peds is to leave them in for an entire week.  We are looking at policy changes that would allow us to keep the PIV in longer for all patients, as it seems we are changing perfectly good IVs just because...  I believe that is becoming a standard nationwide?

PIV 4 days

What percentage actually last 4 days without a complicaiton? 

Old Maki study said about 20%


Your exactly right Kathy....

Your exactly right Kathy....


The overriding point is that

The overriding point is that a set number of hours for a dwell time (e.g. 72 or 96 h) produces the same number and rates of complications as when the catheters are changed based on clinical indications (signs and symptoms of any complication). There is no longer a magic number of hours. They must be removed immediately at the very first sign or symptoms of any complication. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Matt Gibson CRN...
Clinically Indicated

Believe it or not I have heard nurses say about a red, swollen, painful site that "it hasn't been in 96 hours yet. Can't we leave it?" So what we have done is added to our policy the verbage " clinically indicated" site changes. The end result we hope is going to be the nurses will be more aware of the indications (s/s of complications) to change the site regardless of the dwell time and still call the Vascular Access team/ IV therapy when sites have dwelled for 96 hours or more.With this policy change we are not bound by policy to change a site that has no s/s of complications. The IV Team at the hospital I work make a strong effort to assess every site over 96 hours anyway, but we believe the primary care nurse should have this infomation as well.

Matt Gibson RN, CRNI, VA-BC

THe Heart Hospital

Deaconess Health Systems

Newburgh , IN


CDC 96 hour routine rotation vs INS recommendation

My hospital moved from 36 hour to 96 hour routine rotation and PRN a few years ago and are slowly moving to site assessment to be our guide to extend dwell time beyond 96 hours. Infection control nurse is requesting a response from my list serve just how many hospitals are following the INS guidelines in particular in CT. thanks

Kathy C.

Dawn Allsman
 I wrote my capstone on this

 I wrote my capstone on this subject (available by request) I would suggest researching the Cochrane report which is a compilation of all of the existing studies regarding extending dwell time. Dwell times with certain catheter types can be left in (clinically indicated) for up to 144hrs without increased rates of phlebitis and/or infection. Also, I would log onto and search your facility for ALOS. This is a public report regarding Medicaid/Medicare. This would give you a good idea of the amount of money your facility could save by extending PIV rotation to CI. For example, hospital A ALOS is 5.6 days and Surgical floor is 7 days. By your existing policy, the PIV would be replaced 3x, instead of once or maybe twice

Saleen161's picture
Your capstone project

Im trying to understand the resistance of changing to clinically indicated for PIV changes, I would love to be able to read your capstone if you don't mind sharing?

Mark R Hunter

cheryl ferraro
cheryl ferraro's picture
IV sites changes

We recently changed our policy to follow the standards. We have support from our IC service. This means our nurses should assess their sites at the beginning of their tour and during their shift. The patients are also taught the s/s of when an IV may be going bad so they can report to us. Naturally we would then change the site. A majority of our patients are difficult to gain access so changing to meet the standards (there is no optimum dwell time) works for us. It also makes compliance easier.

Cheryl Ferraro RN, CRNI

Dwell Time - Clinically Indicated

We have changed to clinically indicated. Should there be dressing changes if the patient is here > 7 days?

Darla Silavent

 Yes, there should be

 Yes, there should be dressing changes. See 2016 INS SOP on Site Care. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We will be changing our

We will be changing our policy soon to reflect changing PIV site when clinically indicated.  We plan to monitor PIV sites for awhile to ensure nurses are restarting PIVs when complications arise.

PIV changes

HI Alma: we switched to clinical indicated restarts ~ 2 years ago; clinical setting community. The average dwell time l time is ~ 2 days longer than when we routinely changed the site and phlebitis and infiltration rates are comparable.
Curious to know what evidence/data the ICP has to support her decision.

Wendy Erickson RN
We are in the midst of

We are in the midst of exactly the same situation, only difference is that it is our ID docs who are not supporting this change. We currently change PIVs every 96 hours. Both of our ID docs worked previously in other institutions where the change to "clinically indicated" was made and they saw a huge rise in phlebitis and blood stream infections. Now, one wonders if they just started paying more attention because of the change and the numbers were actually no different, but I don't know the answer to that. We will not be changing our practice without their support.

Wendy Erickson RN
Eau Claire WI

 My bet would be on the

 My bet would be on the increased attention to PIVs revealed what was there all along and the actual numbers would be no different. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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