IV catheter changes..

[RNnewbie2014]

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?

[onedayitllbeme]

From field change after 24 hours. Internally 4 days. It use to be 3. In the elder sometimes confused population they rarely last that long unfortunately.

[FurBabyMom, MSN, RN]

One thing you will encounter quite frequently is experienced nurses who go by old guidelines and do not change their practice (some out of stubbornness, some because policies change without them knowing, some because the go with a more conservative older policy rather than an EBP new policy)--I am guilty of it at times too...we all are. Another example, some nurses insist on checking the Foley balloon before catheter insertion, even though the policy no longer calls for that.

BTW, there is no policy at my hospital for the timeframe for IVs to be removed.

It's funny you mention the foley thing. Most of the nurses I work with check the balloon. Almost exclusively because it's a giant PITA for there to be balloon problems with a foley if we're doing a longer procedure and positioned prone or laterally (and we're mostly checking to make sure the balloon doesn't burst when filled). Good luck getting that foley in under the drapes. If I was working on the floor or elsewhere, I'd be fine not checking the balloon.

I believe our facility policy is to use lines so long as the site is without complications and flushes easily. Most patients are not in the hospital long enough to have actual issues from it, and those that are generally are candidates for some kind of central access (PICC/CVC).

[wanderlust99]

I've worked as a traveler at dozens of hospitals and most hospitals policy is change every 96 hrs. If the patient is a hard stick then it'll stay in. I thought it was more for infection prevention.

If they plan on keeping patients for awhile, my current hospital is really good about getting PICC lines placed pretty soon.

[Nenja]

I'm in Peds and we don't have that policy. If it ain't broke...don't fix it! :) Rarely would it last that long anyway though for a lot of our kiddos.

[wyosamRN]

IV abx for weeks should probably be considering a PICC line.

[Twinmom06, ASN, APN]

Most places require it unless orders obtained to keep current IV

This is how our facility does it and the "keep current IV" usually only buys one more day until d/c

[Asystole RN]

As a clinical educator for a medical device manufacturer who specializes in vascular access, infusion therapy, and oncology I can tell you that it is a growing trend to keep the PIV in until clinical indications present to actually change the PIV.

The modern standard is to maintain the IV until you need to change it, the Peds world has been doing this for years and years with a mountain of data supporting the practice along with professional nursing organizations and others.

The majority of hospitals have a 72hr or 96hr policy but many have changed over or are considering the change. Give it 5-10 years and nearly every hospital will have an unlimited dwell policy.

[arose93]

My professors emphasized a 72 hour rule for both the iv catheter and tubing. Even the hospital we did our clincals at uses a 72 hour rule.

[nrsang97, BSN, RN]

At my facility I am actually not sure how long before the IV site is changed. I have restarted some patients every 24 hours. I just got really irritated with a floor nurse (I am rapid response) due to the patient having an infiltrated IV. His left bicep was double the size of the right. I told the nurse to pull the IV and I would place a new one. He tried to tell me the IV was fine. I told him "You will pull the IV in his bicep and I will place a new IV in his opposite arm." The patient's arm looked terrible. I felt bad for him.

[smartin13]

Any IV not started in my facility has to be changed out within 24 hours. Our IV's expire after 4 days (old policy was 72 hours) and have to be changed unless we have an order from the MD. Some units do not stick to this policy, however our manager believes in this policy and audits our IV's several times a week.

[mrsboots87]

I am just a student and our instructors have drilled into our heads that PIV catheter HAVE to be changed q94hr unless they are a hard stick or have an unusable arm or things like that. But I recently did an EBP research project on preventing IV catheter infections. I researched all IV catheter types, but for PIV the old suggestion was to change q72-96, but current research finds no significant difference in infection rate between q72-96 and only as needed when the site is properly taken care of and monitored frequently. The tubing guidelines are still the same but now it's just up to hospitals and staff to get with current evidence. But if course by the time that happens, new evidence will be available lol.

[akulahawkRN, ADN, RN, EMT-P]

Any IV not started in my facility has to be changed out within 24 hours. Our IV's expire after 4 days (old policy was 72 hours) and have to be changed unless we have an order from the MD. Some units do not stick to this policy, however our manager believes in this policy and audits our IV's several times a week.

That's likely partially because they do not have any QA/QI power over those that do not belong to the same facility and that they can not trust that whomever started that IV did so in a clean manner.

The train of thought is similar to receiving blood draw tubes from another facility that were sent with the patient. In order to use them, you'd have to trust that those were, in fact, properly drawn and are actually that patient's blood and not someone else's sent by mistake.