IV site rotation

[BriGuyRN]

Throughout nursing school, I was learned that IV sites were rotated q72h.

Recently, my hospital has a new policy that they do not need to be rotated based on time, but condition instead. Field starts do not get changed unless the site is bad. If the site is clean, patent, non reddened, and not infiltrated, it stays. The dressings aren't even dated anymore.

Does anyone else have this sort of policy in action at their facility?

I understand that pt comfort is at stake, and less vein punctures lowers chance of bloodstream infection, but so does aseptic technique.

[MunoRN, RN]

It's interesting how much validity we ascribe to something just because that's how we've been doing it. The need to change peripheral catheters based on dwell time has never been supported by the evidence. Assessment based site rotation however is known to be an accurate method for avoiding site complications.

Cochrane Collaboration, the top of the evidence based pyramid, came out with their summary of the evidence in 2010 and found no evidence to support changing peripheral IV's based on time. Based on that an other data that supported an assessment-based rotation of sites, the Infusion Nurses Society changed their recommendation from time to assessment for basing the need to change sites.

My facility has been changing site based on assessment rather than time for 2.5 years now and have had no issues with it. We have seen a higher rate of catheters D/C'd prior to 72-96 hours due to site assessment, which is the huge advantage to making assessment the primary decision driver for site rotation vs time; you're more likely to get them out when they start to go bad, which should be the overall goal.