PIV rotation for pedi pts?

[gospursgo07]

Hello all, I have a question for you pedi nurses, or anyone who can offer some insight...

My 5 year old niece is in the hospital and is getting IV antibiotics and fluids. She was admitted Friday morning (9/12), and when I went to visit her today (9/15) I noticied that she still had the same PIV as when she was admitted. She stated it did not hurt her, but I noticed a red area above the insertion site.

I worked adult med-surg for 2 years, and our hospital policy was to rotate PIV sites every 72 hours. I mentioned this to my sister, as I thought she may want to inquire about it when the nurse was available.

The nurse later came into the room (while I was there), and my sister asked about the IV site and how often they are rotated. The nurse stated that "We usually don't start a new IV unless it starts to hurt, because they are pedi pts. We try to keep them in as long as possible." She also stated, "We will keep an eye on it" .

I thought this was strange seeing as how the IV can become another source of infection for an already compromised pt. My niece is going to remain in the hospital for at least 3 more days for IV abx. Of course I do not want my niece to have to go through another stick, but if it is necessary, so be it.

Am I crazy and over-reacting, or is there such protocol for PIVs and pedi pts?

Thanks in advance for your responses!

[Penguin67]

It is not at all uncommon in peds to keep a good IV and not rotate it unless there are problems. Inknow in adult, there are rotate policies. But research has shown that rotating a site in peds doesn't make a clinically significant difference in the prevention of infection. If you can keep an IV in for 72 hours, you are doing something right! (Some kids knock or pull them out in that time frame anyway.) Our peds philosophy for IVs is "If it ain't broke, please please please don't try to rotate it!"

[wooh, BSN, RN]

Totally agree with above. Like she said, the research doesn't support site rotation. And parents and kids SURE don't support it!:) (Nor do the nurses that have to hold kids down to do it!)

[PedsED-RN]

As stated already, we usually keep them as long as they are working and there are no problems. If it seems like access is going to be needed for any extended period, our hospital will generally go for a Broviac central line. Hope this helps ease your mind......peds definitely is a different world when you are used to adults. =) Hope she is doing well!!!

[Pedi-Gree, BSN, RN]

Our policy is the same. Don't abandon a PIV that's infusing well. My son once had one that lasted 13 days. He was five and he was getting antibiotics and fluid boluses through it. We were so glad that it held up because he was already short on veins.

[PICNICRN, BSN, RN]

Never, ever, ever, do we change out a PIV that works just to put in another! Research does not support doing so..... and it's just plain mean:crying2:!

Just be happy it still flushes well after 3 days and keep your fingers crossed!

[iluvivt, BSN, RN]

Perfectly acceptable in the peds population. Leave in as long as asymptomatic and remove as soon as it does become symptomatic. The risk of infection is so low with PIVS and the chance of running out of suitable sites is far too great in this population. It is really a matter of vein preservation and being able to deliver the prescribed course of therapy.

[scribblerpnp]

Just adding my support! At the two pediatric hospitals I have worked (one small town, the other a top 10 in the country), NEVER get rid of a good working IV, no matter how old.

[elizabells, BSN, RN]

Yup. Leave 'em in, flush 'em qshift if they're not used, and thank the IV gods if you keep one going for more than 72 hours.

[gospursgo07]

thanks for all of your replies!!!

my mind can rest easy now! :)

she is doing much better now, and should be home at the end of the week.

thanks again everyone!