IV catheter changes..

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I was asked 2 days ago at my job if my school had stressed changing peripheral IVs every 96 hours.. I do not recall this being emphasized... What is the EBP about this? I mean of course I know if a patient is experiencing infiltration or phlebitis, I am going to change it... But other than that I was JW is there hard evidence that changing a peripheral IV every 96 hours is appropriate?

Specializes in Emergency/Cath Lab.

What about field starts? How long do your facilities allow those to stay in. I had it badgered in my head 24 hours for field and 72 for facility started. Its nice hearing this new standard of use it till you lose it.

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Specializes in Inpatient Oncology/Public Health.

Ambulance starts still are supposed to be changed in 24 hours but an IV from another facility can be treated as our own. I always thought it was weird we had to change another facility's IV when that was the rule. Don't they insert them the same we do?

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Specializes in Critical Care.
What about field starts? How long do your facilities allow those to stay in. I had it badgered in my head 24 hours for field and 72 for facility started. Its nice hearing this new standard of use it till you lose it.

We no longer limit field starts to 24 hours, the same rotate-based-on-assessment rule applies. The 24 hour rule was based on research from the early 80's, mostly at a single facility, which found a higher rate of complications with field starts. These were IV's started usually without any skin asepsis, no gloves were used, hard metal needle IV's, and no occlusive dressing, just taped in place. The standards for IV's started in the field today have changed drastically and typically are at least as good if not better than those used in the hospital. The exception would be a known compromised start.

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Specializes in Emergency Department.
I was taught no more than 5 days, but as a pt with an IV in the back of my hand for 4 days I can tell you how bad it was. My hand was 3 times its normal size from the fluids going in for so long.

Your hand was 3x normal size because the IV was infiltrating, not simply because it was in for 4 days. Also nobody probably noticed it and said all was fine. During my preceptorship I had a patient whose IV had infiltrated and was painful when I'd flush it. He just thought that was normal. I restarted the line and, much to his surprise, it was absolutely painless when I flushed that new line... Though I've done hundreds of IVs over the years, his was only about the 5th I'd done in about 10 years.

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Specializes in ER.

Is it every 96 hours or is it 72? I know one is the tubing. I don't really care as I am in the ER and we almost never have people come in with sites. The exception is some woman who was in bad shape who came in with a port accessed. It was kind of strange.

My old job had a rule that squad starts had to be changed within 24 hours but they don't have it in the new facility. Since squads used their own equipment, they couldn't guarantee that the starts were "clean." Plus they realized that it may not have been started under ideal circumstances.

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Our facility just changed our policy last week. The previous requirement was tubing and PIV should be changed every 72 hours (if possible for IV).

The new policy is to change tubing q96 hrs and PIV's now do not have to be changed unless there are clinical indications to do so. I like the new policy as I always felt like patients were receiving unnecessary needle sticks. I just hope my coworkers are diligent in flushing and continually checking for infiltration.

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I haven't been on the floor or in the ER or L&D for about 6 years. I'm hospice now. We do sub-q insertions for CADD Pumps for pain control.

But, I remember being taught Q72H for IV's and change the field IV as soon as the patient is admitted to the floor. I've always thought this was silly. If the IV is fine, why mess with it? And tubing changes? I always thought that introduced more bacteria into a closed system.

I don't think it is necessarily wrong for a more experienced nurse to pass on information - but I'd follow the protocol your hospital has set up even if you think it might be silly. I'm glad to read that the policy I had to work with is changing but it might not have changed at every hospital.

I just remembered a couple of things I was doing 17 years ago that other nurses outside my facility were appalled about . .. . we still used Demerol IV for pain and Phenergan IV for nausea. It was the norm where I worked.

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Specializes in Inpatient Oncology/Public Health.
Is it every 96 hours or is it 72? I know one is the tubing. I don't really care as I am in the ER and we almost never have people come in with sites. The exception is some woman who was in bad shape who came in with a port accessed. It was kind of strange.

My old job had a rule that squad starts had to be changed within 24 hours but they don't have it in the new facility. Since squads used their own equipment, they couldn't guarantee that the starts were "clean." Plus they realized that it may not have been started under ideal circumstances.

Coming in with an accessed port isn't really weird. They often access them in the clinics. I work Onc and we will have direct admits from Onc offices or clinics with the ports accessed sometimes. Of course if it doesn't have the bio patch on it, we have to change the dressing.

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Specializes in Emergency Department.

My understanding as to why field starts were changed within 24 hours of arrival is two-fold: one is that field starts are usually considered to be "dirty" starts (even if they're not), and two is that the hospital has no ability to control the practices of the field personnel unless they're directly employed by the hospital. It's essentially a similar reason as to why field lab draws aren't usually utilized by hospitals.

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Specializes in Emergency, Telemetry, Transplant.
Coming in with an accessed port isn't really weird. They often access them in the clinics. I work Onc and we will have direct admits from Onc offices or clinics with the ports accessed sometimes. Of course if it doesn't have the bio patch on it, we have to change the dressing.

My hospital is attached to the cancer center for our hospital system, so we see a lot of Onc patients. Some come in with vascular access--PICC, tunneled cath, accessed port. Many get a bolus of fluids q evening, some have continuous opioid infusion, others get home chemo, etc. Most ports come in and appeared well cared for--i.e. dressing that is CDI, good flush/blood return, etc. PICCs can be hit or miss.

It is a little different, but dialysis caths are, by far, the most "mistreated" lines that patients come in with. We are lucky if they have a dressing on it, and it is usually a dirty, half pulled off dressing. Often times, caths have crust on them with sutures coming off. Pretty yucky!

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Specializes in Med/Surg, Academics.

Regardless of EBP, you have to go by facility policy until the policy is changed.

off topic...

I was almost written up for an IV that was 72 hours old not changed on my shift. I distinctly remember endorsing the IV change to the noc nurse and documenting my endorsement. The noc nurse "reported" me for not changing the IV, and my documentation saved me. During that stupid, nurse-on-nurse, insignificant investigation, I and my manager found out policy was 96 hours.

Some time after that, I requested assistance from the nurse educator on a difficult IV change. The IV was 6 days old, and the nurse educator went ballistic, saying all nurses from 72 hours on should be written up. I said the policy was 96 hours, but the site was still too old per policy. She became indignant at my correction of her understanding! Our back and forth was like "It's 72, dudette!" "No, educator, it's 96!" We did that a couple times, and that was the end of it...I just gave up and said, "Check the policy." Guess what? She reported me to my manager for "unprofessional conduct." When my manager talked to me, she rolled her eyes and said, "Consider yourself talked to. Don't worry about it."

I love my manager.

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My hospital policy is every 3 days which I didn't learn in school. But in school isn't really world. I find this annoying since most of the patients need to be on antibiotics for weeks and have to have their Ivs every 3 days

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