What's Your Longest Lasting PIV?

bgxyrnf, MSN, RN · Jul 23, 2018

The 3-4 days things is a myth, I have never seen any actual evidence that it benefits a patient to rotate IV sites unless there is infiltration or obvious infection. 40 days is bit long though and I would question why someone would need IV access for that length of time. If it was for antibiotic therapy (discitis, osteomyelitis etc) a PICC should really be inserted and the patient d/c for outpatient infusions.

I am not familiar with the patient's overall hospital course nor why s/he remains an inpatient as opposed to discharge to a SNF/rehab. It could be insurance related or because s/he's worn out his welcome at the local facilities or because s/he's developed complications (I don't even know why s/he was originally admitted) or simply hasn't responded to therapy as hoped.

Regardless of the foregoing, why do you consider "40 days a bit long?" And if s/he's remaining an inpatient for whatever reason (and like any hospital, ours is aggressively looking to discharge as soon as they reasonably can), what would be the justification for a PICC line if peripheral access is suitable?

AnnieOaklyRN, BSN, RN, EMT-P · Jul 23, 2018

I love your original question and the responses. I did not know the new studies about leaving IV's in more then 3 days, but I have been working out patient surgery for a long time.
However a PICC is "peripherally" inserted, often in the antecubital fossa, it is not a "central line." They can remain 6 - 12 months, but that was my quick Google search, I may not be up to date on PICC's either? But even with that I guess if the IV is working fine why bother?

PICC is absolutely a central line, as the end is in the superior vena cava. The central part of Central line has to do with where the tip of the line is and not where it is placed!

A midline, which unfortunately looks very similar to a PICC is not a central line and terminates generally just before the axilla.

Annie

Happynurse2222 · Jul 23, 2018

I work in ER and the hospital just rolled out a new policy that we have to pull EMS lines and lines from other hospitals that are put in anything other than the arms. I personally don't see the good in pulling a perfectly good line and sticking someone again, especially if they are a hard enough stick that they ended up with a line in their foot or neck.

MunoRN, RN · Jul 23, 2018

The reflexive desire to change things that don't need to be changed isn't new, we used to do the same thing with Ventilator circuits as well, it just 'felt' right to change then frequently, as it turned out that only increased infections. Same goes for IV tubing. The idea that sometimes doing nothing is more beneficial than doing something has long been a hard habit for us to break.

MunoRN, RN · Jul 23, 2018

The practice of routinely changing out EMS starts is a bit outdated as well. There once was good evidence that these IV's were problematic, although that was based on 2 studies from the early 80's where EMS staff were placing metal IVs with just a piece of tape on it (no dressing), the didn't wear gloves or routinely perform any hand hygiene or site cleansing before placing the IV. That's not a generally accurate description of current EMS starts, the EMS standards for IV insertion in the area where I currently work make them if anything more reliable than hospital placed IVs.

psu_213, BSN, RN · Jul 23, 2018

I work in ER and the hospital just rolled out a new policy that we have to pull EMS lines and lines from other hospitals that are put in anything other than the arms. I personally don't see the good in pulling a perfectly good line and sticking someone again, especially if they are a hard enough stick that they ended up with a line in their foot or neck.

Replace them while they are in the ER? The first place I worked as an RN required that medic lines and lines from other facilities have to be replaced in 24 hours.

Otherwise, in the ED, if they have a patent, clean line--that's what is going to be used.