Rotation of IV sites based on clinical indication.
Has anyone out there changed their IV policy regarding rotation of IV sites to only when clinically indicated? We are considering doing this and I would appreciate any feedback.
I'm actually quite perplexed by the change of this standard. To me, "clinically indicated" means at early signs of complication. Well then it's too late to save that vein. From a venous preservation standpoint that is counterintuitive. I cut my teeth in vascular access by rotating sites every 72hours. It wasn't unusual to use a vein twice after it had a "rest" period. Essentially this new paradigm says that peripheral veins are sacrificial but don't let it get so bad that you have to report an adverse event. I can't believe the INS got behind this.
We are considering changing the vernacular of our policy that in effect states: Change peripheral IV access sites every 96 hrs OR if there has been difficulty in obtaining access, and/or the site remians cool, clean, dry, intact and patent, without signs or symptoms of compromise, that line can remain, closely monitored and changed when "clinically indicated". We haven't nailed down the specific language yet but are working on it. Our experience has been that some of our patients have a perfectly functional, pristine appearing IV sites that, but because it has reached the 96 hr time limit, mandates a "policy driven" change out rather than a "clinically indicated" change out. We're interested in everyone's feedback...more to come
I would caution to not write this language as a policy. Write it as a practice guideline. This language requires nursing assessment, knowledge application, and critical thinking - things that a policy can not addres. A policy is a statement that is nonmodifiable and nonnegotiable. The nurse, physician, or anyone can alter it. I don't think your language would be a policy. It is good language but it is a practice guideline instead. Lynn
It appears there is a great deal of misunderstanding about this new approach to peripheral IV catheter changes. First it is important to understand that these studies have clearly demonstrated that catheter changed at 72 or 96 hours have the SAME outcomes as those changed when clinicall indicated. This means the same rates of phlebitis and infiltration/extravasation, etc.Out intervention of automatic removal and insertion of a new PIV at 72 or 96 hours adds to costs and nursing labolr, patient discomfort and does not provide any benefit. No difference between the 2 groups. There are several other facts demonstrated in the literature. The majority of PIVs do not last beyond 48 hours. Most are removed for signs and symptoms of complications before this 48 hour mark. Those that last beyond 48 hours are less likely to develop a problem. So there is nothing magic about 72 or 96 hours for changing a catheter and these time limits have been shown to NOT reduce complication rates. I would not like to be a paitent planning on discharge the next day, have 2 more doses of antibiotics scheduled, an IV site that has no problems, and have the nurse want to change it. Then she has to stick numerous time to get a new PIV in. This destroys veins, not preserves them. Additionally, there are 2 studies that have demonstrated that when patients complain of pain or have phlebitis with the first catheter, they are much more likely to develop the same complication with the subsequent catheters. So our attention must move from a rigid number of hours to remove and replace a PIV to proper site selection, insertion technique, catheter and joint stabilization to reduce complications. Limiting the amount of time it resides has no impact on reducing these complications. INS Standards are based on the evidence and this is what the evidence is telling us. Lynn
I'm actually quite perplexed by the change of this standard. To me, "clinically indicated" means at early signs of complication. Well then it's too late to save that vein. From a venous preservation standpoint that is counterintuitive. I cut my teeth in vascular access by rotating sites every 72hours. It wasn't unusual to use a vein twice after it had a "rest" period. Essentially this new paradigm says that peripheral veins are sacrificial but don't let it get so bad that you have to report an adverse event. I can't believe the INS got behind this.
Darilyn
We are considering changing the vernacular of our policy that in effect states: Change peripheral IV access sites every 96 hrs OR if there has been difficulty in obtaining access, and/or the site remians cool, clean, dry, intact and patent, without signs or symptoms of compromise, that line can remain, closely monitored and changed when "clinically indicated". We haven't nailed down the specific language yet but are working on it. Our experience has been that some of our patients have a perfectly functional, pristine appearing IV sites that, but because it has reached the 96 hr time limit, mandates a "policy driven" change out rather than a "clinically indicated" change out. We're interested in everyone's feedback...more to come
David Bruce RN
I would caution to not write this language as a policy. Write it as a practice guideline. This language requires nursing assessment, knowledge application, and critical thinking - things that a policy can not addres. A policy is a statement that is nonmodifiable and nonnegotiable. The nurse, physician, or anyone can alter it. I don't think your language would be a policy. It is good language but it is a practice guideline instead. 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
It appears there is a great deal of misunderstanding about this new approach to peripheral IV catheter changes. First it is important to understand that these studies have clearly demonstrated that catheter changed at 72 or 96 hours have the SAME outcomes as those changed when clinicall indicated. This means the same rates of phlebitis and infiltration/extravasation, etc.Out intervention of automatic removal and insertion of a new PIV at 72 or 96 hours adds to costs and nursing labolr, patient discomfort and does not provide any benefit. No difference between the 2 groups. There are several other facts demonstrated in the literature. The majority of PIVs do not last beyond 48 hours. Most are removed for signs and symptoms of complications before this 48 hour mark. Those that last beyond 48 hours are less likely to develop a problem. So there is nothing magic about 72 or 96 hours for changing a catheter and these time limits have been shown to NOT reduce complication rates. I would not like to be a paitent planning on discharge the next day, have 2 more doses of antibiotics scheduled, an IV site that has no problems, and have the nurse want to change it. Then she has to stick numerous time to get a new PIV in. This destroys veins, not preserves them. Additionally, there are 2 studies that have demonstrated that when patients complain of pain or have phlebitis with the first catheter, they are much more likely to develop the same complication with the subsequent catheters. So our attention must move from a rigid number of hours to remove and replace a PIV to proper site selection, insertion technique, catheter and joint stabilization to reduce complications. Limiting the amount of time it resides has no impact on reducing these complications. INS Standards are based on the evidence and this is what the evidence is telling us. 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