IV site changes

[SRW]

I'm looking for information on facility policies re frequency of uncomplicated peripheral IV site changes. We currently change @ 72 hours. Anyone changing @ 96? Thanks for the help!

[nursebedlam]

Have the q72h protocol.

[lucy2196]

First, you must be sure to adhere to the current policy within your facility whether 72 or 96 hours for an uncomplicated peripheral IV. Second, you must assess the site within the protocol allowed dwell time to see if a change is necessary.

The current INS standards and current research suggest there is very little difference in the amount of phlebitis between 72-96 hours. However, if you are infusing :angryfire (jet fuel) think of vancomycin and other harsh medications the osmolality of the infusate will definitely impact the dwell time of any peripheral IV. For IV sites that are uncomplicated according to the standard it can remain 96 hours and the CDC also supports this. However, you are unprotected if you do not have a policy to support an extended dwell time without an MD order to extend the dwell time. If you think your facility would be better suited to a longer dwell time, I would bring this up for discussion with the Infection Control nurse in your facility. They are usually very involved when in comes to facility policy changes, they are generally aware of current guidelines, and attend APIC meetings where new guidelines lectures are presented. The other option is to do your own research: www.cdc.gov and check the Guidelines For the Prevention of Intravascular Catheter-Related Infections which addresses peripheral IV's, Central Lines, Mid-Lines and Picc's. The INS Intravenous Nurses Society has the "Infusion Nursing Standards of Practice" there is a ton of information out there, a prudent nurse must arm his or herself, always!! It is better to be aware of current literature and guidelines unfortunately, many nurses become complacent in their position and forget that the medical strategies of today are much different than those learned in nursing school. We have to be aware of changes in practice, so thanks for bringing up the issue and staying interested, I wish there were more folks out there interested in staying up to date!!!

Lucy

[bobnurse]

72 hours is the standard of care. Anything over 72 hours and the risk s of Phlebitis and thrombophlebitis go up. Just for information a MD can write an order to extend a PIV but, it does not take the responsibility away from the nurses if a complication occurs after the 72 hour standard of care. I know that this sounds paranoid but I teach IV Therapy classes and people do get sued for this. If I were to leave in for longer thatn 72 hours it would be only on a patient that is expectant and is a very difficult insertion. But, I would still be responsible for that decision.

Randy Ross R.N., B.S.N

IV Nurse Consultant, President & CEO

IV's Etc... LLC

Vascular Access

& Consulting

www.ivsetc.com (http://www.ivsetc.com)

[email protected]

IV's should be changed every 48-72 hours....This means you should be assessing your IV's at the 48 hour mark to go another 24 hours. They should never be left in, even if theres an order. Most nurses dont have a good understanding of all the problems that could occur post 48 hours, and especially post 72 hours. At our facility, we dont allow IV's to go past 72 hours no matter what an "order" says....If your patient is a difficult stick, you should of assessed that prior to starting the intravenous therapy, and got a Central line, PICC, or Midline placed........IV therapy is a new but old area for liability, so dont put yourself in a bad situation. We use the Infusion Therapy in Clinical Practice by the Infusion Nurses Society as a reference for all of our IV policies.....Many courts use them to base if what your doing is the "standard".