Frequency of changing peripheral IV catheter

[Neohippy]

Hi, Infusion Nurses :)

I am a new nurse and have read that the routine changing of peripheral IV catheter sites q.72-96 hours is discouraged now and that IV site should only be changed "as needed" (meaning, I assume, any complication that develops like phlebitis, infiltration, etc.) My question is this: If there are no complications, what is the maximum amount of time a peripheral iv catheter can be left in? On what day on average does an IV "go bad" and have to be changed? Thanks in advance.

[Asystole RN]

This is the first time I have heard of the PRN approach, we maintain a 96 hr hard-stop but I am not surprised. The length of time a peripheral can/should stay in highly depends upon your facility and how well you are doing with them.

There are many factors that have to be considered when looking at PIV longevity;

Size of catheter/size of vessel ratio

Where the vessel has been cannulated

What is infusing, is it an irritant or vesicant?

Is the infusion continuous or intermittent?

Underlying comorbidities

etc.

Personally, if there are no problems then there are no problems. I like the idea of maintaining until it is needed to change. I would however recommend that if the patient needs a PIV for longer than a few days they most likely warrant a midline, PICC, or other advanced vascular access device.

[Neohippy]

Thanks, Asystole :)

[MunoRN, RN]

My understanding is that the current INS recommendation is to change sites only based on assessment. Their recommendations aren't publicly available, so someone who has access to them might be able to give you more specifics.

[LoveMyBugs, BSN, CNA, RN]

My facility is as needed, but I work in pediatrics. So the less pokes the better for the kids, but I believe on the adult side it is every 96 hours.

[turnforthenurse, MSN, NP]

Q72H where I work.

[Asystole RN]

The INS Standard of Practice are available to the public, you just have to be willing to pay a nominal fee for it just like you do for most references and journals.

The INS does not give a hard dwell time, just that the facility must adopt P&P regarding it. The CDC however does have something to say about it.

The CDC's most current recommendations;

Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011

Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days. Category II

There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults [36, 140, 141]. Category 1B

No recommendation is made regarding replacement of peripheral catheters in adults only when clinically indicated [142-144]. Unresolved issue

Replace peripheral catheters in children only when clinically indicated [32, 33]. Category 1B

Replace midline catheters only when there is a specific indication. Category II

P.S. The CDC's recommendations always come with a qualifier so that the reader can interpret the strength of the recommendation, those categories are extremely important to understand what the recommendation means.

[KelRN215, BSN, RN]

No routine PIV changes in kids here. The longest I've seen one in was 10 days, I think. That's a rarity though, most kids have burned through 5 or 6 IVs in 10 days since they do things like bite them and pull them out.