IV site rotation

  1. Throughout nursing school, I was learned that IV sites were rotated q72h.

    Recently, my hospital has a new policy that they do not need to be rotated based on time, but condition instead. Field starts do not get changed unless the site is bad. If the site is clean, patent, non reddened, and not infiltrated, it stays. The dressings aren't even dated anymore.

    Does anyone else have this sort of policy in action at their facility?

    I understand that pt comfort is at stake, and less vein punctures lowers chance of bloodstream infection, but so does aseptic technique.
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    About BriGuyRN

    Joined: Oct '12; Posts: 16; Likes: 12


  3. by   Sun0408
    We change every 4 days. That's pretty standard around here but I haven't heard of no time limit.. I posted to see what others are doing or what EBP states..
  4. by   NurseAmie
    How can an invasive procedure come to the point that a dressing doesn't even need replaced routinely? Isn't this sort of the opposite of infection control, and hearing about how so many people obtain hospital infections, and how antibiotic resistance is increasing? Gross.
  5. by   Ir15hd4nc3r_RN
    field IV's are supposed to be changed at or after 24 hrs.. Iv's placed in our hospital are good for 4 days as long as the site & dressing is alright. obviously if there's leaking, or the IV's not working right, it's gonna get changed - regardless of whether it was put in a day or 2 ago.
  6. by   Ir15hd4nc3r_RN
    dressing changes & fixing IV connections can be very helpful, but don't always work if the IV is just in a bad spot.
  7. by   iluvivt
    INS Position Paper
    Recommendations for Frequency of Assessment of the Short Peripheral Catheter Site

    I thought is was easier to just post the link since the position statement is so long.

    I changed our PIV policy as well to be based on assessment. I gave it quite a bit of thought and read a few things I had not read before to help solidify my recommendation. I remember when I was concerned many years back now when we extended our change time to 96 hours until I thought about it. I see very few PIVs last much longer than 6-7 days and most last 2-4 days. The ones that I see that last are usually when the patient is receiving isotonic or near isotonic IVFs or are locked off for PRN medications and are NOT in the ACF or at areas of flexion and are 20 gauge or smaller. I have been starting IVs and looking at PIV sites for 32 years so that is a lot of IV sites.

    Remember that a TSM dressing stays on a CVC for a week so it can certainly stay on a PIV for a week with equal benefit. A PIV site can also benefit from nursing care that is similar to CVC care in that we need to scrub hubs faithfully,use impregnated alcohol protectors,use a no touch technique for all starts, recognize complications early.plus more.

    I DO not agree with not dating the sites b/c it is a piece of information I always like to know but if you are basing it on assessment technically it should not matter.

    I just went to an annual IV conference and it was no surprise that studies show that the IV sites most likely to get infected come from the ED and field starts and there is way too many cases of thrombosis from the ACF site. We too change our field start ASAP and are discouraging ACF sites and to change those out when feasible.
    Last edit by NRSKarenRN on Apr 11, '13 : Reason: added title
  8. by   Anoetos
    I've never heard of that. It doesn't sound safe. Unless there's new data supporting it, I hope you're tracking bacteremia rates in relation to the policy.
  9. by   BriGuyRN
    So since posting this, I had a pt with a right forearm 20g that I started 4/2. After a week I got him as an assignment and when I assessed his IV, to no surprise, was the same IV I started - only redressed and reinforced with tape.

    The site looked good but the idea that the catheter has been in place over 80 hours was disturbing. I pretended it malfunctioned and started another.

    I'm going to find the policy and post it in verbatim, and question the rationale behind it.
  10. by   iluvivt
    I have a lot to say and you need to check your policies but I cannot do it now.Briguy I have several things I need you to look at and check into so you can advocate for the best patient care. I will try to post tomorrow.
  11. by   IVRUS
    My company too has a 96 hour rotate policy, and we too find that depending on the medication and site, we may be rotating q 48 or it may last 4 days. Recently, however, we had MD's orders for a prn restart on two patients with really poor venous access, both had issues where they were NOT getting any other VAD type due to their confusion and pulling propensity... and in both instances, the lines lasted for 10 days, and one for 15 days... Whew. Therapy completed successfully. Now, were more diligent site assessments done... Sure. And the dressings were changed q 96 hours as neither were placed per sterile technique like that of a line over three inches.
    If the catheter is placed in a non-traditional setting, like out in the field or in the ER, it should be resited within the first 24 hours. Did that medic make sure he or she cleansed for the appropriate times frame before the VP? Likely not as what good does it benefit if the patient dies from lack of proper medication because the line took SO LONG to insert! Emergency settings are differant than a controlled setting where a clinician can do things right.
  12. by   cjcsoon2bnp
    At my facility our catheters are good for three days and if they were started by EMS they are good for 24 hours. I will say that with patients that have really difficult access or hospice patients we will often get an order from the physician to keep the IV in for as long as it will work and only D/C it if there are clear signs of extravasation or phlebitis. I can remember reading an article about changing IV sites based upon assessment and not on a 3-4 day time limit. I am very curious about this topic and will be sure to read the article recommended by iluvivt.

  13. by   eatmysoxRN
    My facility's policy is every 96 hours. They usually don't last that long (pulled out or simply because we have a ton of obs patients who are only there a short period of time). For the ones who make it to the change time, we will restart if they have good access unless they are going home the next day.

    Sometimes they don't get changed because the patient refuses or because they are difficult to access. Those are options in the charting system for when you chart it wasn't restarted.

    One facility I worked at had a policy that any IV started somewhere other than that facility had to be changed on admission or atleast within 24 hours. They enforced it strictly at the time along with making sure you used the label to time and date the start. They wanted to be sure the site was cleansed for atleast 30 seconds with chloroprep. A lot of patients got mad having to be stuck again after transferring from another hospital.

    I assess my sites frequently and make sure the patient knows signs and symptoms of infiltration or any iv problems. I also tell them that if an infusion starts burning to pinch the line so it will stop infusing and call me. I've seen some bad infiltration from lack of iv assessments.
  14. by   MunoRN
    It's interesting how much validity we ascribe to something just because that's how we've been doing it. The need to change peripheral catheters based on dwell time has never been supported by the evidence. Assessment based site rotation however is known to be an accurate method for avoiding site complications.

    Cochrane Collaboration, the top of the evidence based pyramid, came out with their summary of the evidence in 2010 and found no evidence to support changing peripheral IV's based on time. Based on that an other data that supported an assessment-based rotation of sites, the Infusion Nurses Society changed their recommendation from time to assessment for basing the need to change sites.

    My facility has been changing site based on assessment rather than time for 2.5 years now and have had no issues with it. We have seen a higher rate of catheters D/C'd prior to 72-96 hours due to site assessment, which is the huge advantage to making assessment the primary decision driver for site rotation vs time; you're more likely to get them out when they start to go bad, which should be the overall goal.