Taping IV Catheters

[Zee_RN, BSN, RN]

We currently have a debate at our institution concerning the taping of peripheral IV catheters. Our institution uses IV catheters with 'wings' and we commonly place tape under and over the wings to secure the catheter (forming a kind of 'U' shape--not a chevron and the tape does not touch the insertion site). We then place a transparent dressing over the site. Our Infectious Control nurse says we are increasing the risk of infection by placing tape under the transparent dressing; that we should use only the transparent dressing to secure the catheter. We are worried that we will simply be subjecting the patient to daily restarts as we replace the IVs that have 'fallen' out. Ideas? Comments? Thanks!

[Miss Mollie]

WHile we do not have the wings on our catheters, we tape them in a similar way. I think they would fall right out with just the tegaderm. I used to work at a hospital that had little IV start kits- everything in the kit was sterile- including some quarter inch tape. Perhaps that would satisfy the infection control nurse? currently, we just put a little betadine at the insertion site. and I must admit, on occasion, I tape the entire IV up with silk tape and forgo the tegaderm entirely. It just doesn't hold.

[Loz]

A hospital I have worked in previously in Glasgow, Scotland carried out a bit of research on this. The Infection Control Nurse and IV training nurse carried out a hospital-based audit. The outcome was that an approved IV dressing should be used (e.g.Vecafix or similar) and this should be changed if any blood etc. contaminates it. We were also advised not to bandage IV sites to reduce contamination.

[p.rabbit]

Zee,

You could always ask your Infection Control Nurse about her "science/data". At our institution, there has been much to-do over the years about how to hold IV's and the

infection topic. I think you will find that the research will bear out, that site preparation and hand washing are the key issues as usual. As your IV's fall out at an increased rate, because you are only using Tegaderm or Opsite, consider the increased risk of infection that ensues as you poke more holes in your patients. Additionally, a clean and dry dressing, and a a 3 day maximum use of an IV (except under extreme lack of access times) are probably more effective in the battle to reduce phlebitis. Good luck in your endeavors.

p.rabbit

[deathnurse]

In ER/ICU: Tape it or lose it. Anesthesia or paramedics never gets "dinged" for it, so why should you?

Got "drips" running on a step down unit?: Tape it or lose it.

Elsewhere, consider the access ability and long-term need, patient agitation, safety of not having a line, and make your choice to use tegaderm only, which, truthfully, is probably the "cleanest" way to go. Just not always the "smartest."

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

our unit has the angio sets that have the wings on it. I never tape down the wings only put tegaderm over the wings and the insertion site. Then I really tape down the other entailing pieces very well. Never had one fall out yet. If you are really concerned about them falling out, put a stockinet over the site after you tape it. Patients like it because they feel like they don't have to be quite as ginger around the IV catheter.

[Allan Ferguson]

To Z rn;

I use a micro extension set with most of my IVs. It has a right angle where it attaches to the cathiter. I place an opsite type dressing over the cathiter with the end of the cathiter exposed. I then place a 1/4" tape at a right angle across the hub of the extension set where it goes into the cathiter. Then I bring the extension tubing across this tape and the apply a second tape on top of the first. Move up the extension to place a 1" tape or more as the situation dictates. I use this method for many situations. They hold very well during colenoscopys where the patient must change positions. None have fallen out. I have had patiens take them out. There is no tape under the opsite. Opsite or tape can be replace without endangering the IV site.

[Furball]

Why not anchor down with steri strips and then cover with tegaderm?

[P_RN, ADN, RN]

If you use the sterile tape in a start kit and put it on wiht the sterile gloves in the start kit, why would it be more infection prone than the opsite?

My favorite was a little O shaped foam surrounded opsite. I forget what they were called but they were great and the IV never fell out.

[willie2001]

I agree that good hand washing and proper site preparation are the key to preventing infected peripheral IV sites. At my institution, we place tape under the opsite (chevron under the wings, keeping the tape as far as possible from the actual site). Often, I will wipe the site with betadine and/or alcohol before placing the opsite. I'm not saying that we never see an infected site, but it is very rare.

[kennedyj]

I just tape or chevron the hub above the insertion site. I'd try not to touch the tape at the insertion. Then cover with tagaderm.

[KRVRN, BSN, RN]

We secure with a tegaderm, then chevron at the point where the tubing leaves the tegaderm. Still stays in and the actual insertion site is under the tegaderm. Then we further secure it with a hand board (I work NICU) and more tape. We leave PIV's in until they go bad. Over 3 days or not.