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.
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