IV infection rates?

[RealPrettyNurse]

I am new to doing IV's. Is the risk of infection greater if you leave an iv in for 72 hours or if you were to restart an iv every 48 hours? Basically two iv starts a week vs. three... It is not always possible on psychiatry where I am to leave the iv in, but I think that the two times is less risk of infection-- fewer pokes and less anxiety for the patients.

My infection control staff didn't have any hard facts on actual infection rates to compare. What do you say?

[IVRUS, BSN, RN]

Well I would first refer you to your organizational policy. If they change short term peripheral IV catheters every 72, or 96 hours, that is what you should follow...

However, to answer your question, the CDC's last publication did NOT have a recommended dwell time for short term peripheral IV catheters, but rather stated, "There is no need to replace peripheral catheters more frequently than every 72–96 hours to reduce risk of infection and phlebitis in adults" In children, they should be changed when medically necessary. Therfore, if it goes bad in two days, then, yes, resite it, but prospectively, it could stay in for longer in the absence of complications. Again, refer to YOUR orginization's P&P.

Infections with peripherals IV catheters is largely dependant on the expertise of the inserter and care by those who maintain the IV catheter post insertion: Did staff use appropriate technique with its placement? Did staff ensure that they used the appropriate gauge and length for the vessel? Are staff verifying that the dressing covering the site is C/D/I at all times? Is the nurse infusing the medication aware of what the medication will do to that vessel? What is the medications pH? Osmolarity? Is it an irritant, or a vesicant?

All these questions play a part in the health of the vessels and its longevity, or its demise.

[Asystole RN]

The CDC did not post a hard recommendation because there is no best dwell time, only the best dwell time for that facility and sometimes, that particular unit within the facility.

The studies on PIV infection rates are all over the place simply because the amount of variables that influence PIV infection rates are too numerous. What you facility has to do, and what most do, is start with an arbitrary dwell time and then adjust up or down depending upon the infection rate.

Now one thing that you mentioned that the CDC does have a recommendation for is;

"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"