Jump to content
Experiencing Slow Page Speeds? Read more... ×

What's Your Longest Lasting PIV?

Nurses   (1,559 Views 30 Comments)
1 Like; 10,542 Visitors; 1,208 Posts
If you find this topic helpful leave a comment.
advertisement

I work at a hospital where we sometimes end up with patients for weeks and months. I've taken to tracking my IVs and how long they last.

I had one that was at 21 days when the patient was discharged and another at 27 days at discharge. Right now I have one that's at 40 days and counting...

What's the longest that you've had a PIV line last?

Share this post


Link to post
Share on other sites

Never seen one last that long. Policy is something like they need to be changed every three days due to increased risk of infection. When they aren't in use, I don't think a lot of my co-workers flush them every shift, so they don't last.

40 days though? I don't feel comfortable with that length of time...

Share this post


Link to post
Share on other sites
I work at a hospital where we sometimes end up with patients for weeks and months. I've taken to tracking my IVs and how long they last.

I had one that was at 21 days when the patient was discharged and another at 27 days at discharge. Right now I have one that's at 40 days and counting...

What's the longest that you've had a PIV line last?

Unless PIV means something different than I think it means, three days is the maximum amount of time we're allowed to keep one in any specific site. I can imagine reporting off to the next nurse that the IV was put in 40 days ago ...it wouldn't go well!

Share this post


Link to post
Share on other sites
Never seen one last that long. Policy is something like they need to be changed every three days due to increased risk of infection. When they aren't in use, I don't think a lot of my co-workers flush them every shift, so they don't last.

40 days though? I don't feel comfortable with that length of time...

Unless PIV means something different than I think it means, three days is the maximum amount of time we're allowed to keep one in any specific site. I can imagine reporting off to the next nurse that the IV was put in 40 days ago ...it wouldn't go well!

Current recommendations are to only replace PIV's when clinically indicated based on assessment. There never was actually any evidence to support changing PIV's every 3-4 days in the first place, and multiple RCT's showed no increased risk with changing PIV's based on assessment vs a time schedule. There are however established risks with each IV start, so excessively rotating IV sites is of no benefit and actually exposes the patient to increased risk.

The first of these studies was done in 2008, by 2010 Cochrane had published their position that PIV sites should only be changed based on assessment finding of complications, over the next few years all of the professional organizations had changed their recommendations to changing sites based on assessment rather than a timeframe.

Share this post


Link to post
Share on other sites

Our policy is that they only get changed if they need to be changed. We attempt to change the dressing around them q7d at a minimum of we can without damaging it and the tubing q96 hours but the IV itself can stay in as long as need be.

That being said- anyone at my facility needing IV access for more than 2 weeks would find themselves with a picc unless they were refusing.

Share this post


Link to post
Share on other sites

Pediatric ECMO patient had one last about three weeks. You can't really re-start as they are so anticoagulated so we just left 'em and if they quit working just clamped off until they were off ECMO and their coags had returned to reasonable levels.

Share this post


Link to post
Share on other sites
Current recommendations are to only replace PIV's when clinically indicated based on assessment. There never was actually any evidence to support changing PIV's every 3-4 days in the first place, and multiple RCT's showed no increased risk with changing PIV's based on assessment vs a time schedule. There are however established risks with each IV start, so excessively rotating IV sites is of no benefit and actually exposes the patient to increased risk.

The first of these studies was done in 2008, by 2010 Cochrane had published their position that PIV sites should only be changed based on assessment finding of complications, over the next few years all of the professional organizations had changed their recommendations to changing sites based on assessment rather than a timeframe.

Interesting! This is either not well known or not well respected. A change every 72 hours has been a rule at each job I've had since I've been a nurse. Most of them don't even make it that long, though.

Share this post


Link to post
Share on other sites

Aware of this ^ but I'm not really in an area where it affects me.

Webster, J., Osborne, S., Rickard, C.M., & New, K. (2015, August). Clinically-indicated replacement versus routine replacement of peripheral venous catheters.Cochrane Database of Systematic Reviews, 2015(8), 1-45. doi: 10.1002/14651858.CD007798.pub4

Helton, J., Hines, A., & Best, J. (2016, Jan/Feb). Peripheral IV site rotation based on clinical assessment vs. length of time since insertion. Medsurg Nursing, 25(1), 44-49.

Share this post


Link to post
Share on other sites

I can't imagine having a peripheral in for longer than a few days. I'd think the doctors would prefer a PICC for long-term use.

Share this post


Link to post
Share on other sites

Its a fairly new consensus based on the infusion nursing association (not sure of this is the right name). But I read the consensus, this was like a year ago, and soon after, our policy changed from new iv q3 days to now keeping until not functional, causing problems, or no longer indicated. Your hospital prob just has not changed the policy, but it is a legit one. I work at a multistate hospital system and the PIV policy changed across the board for the reasons PP stated.

Share this post


Link to post
Share on other sites

One hospital I work at adopted the site change when clinically indicated and my other job still wants them changed q3days.

I agree with leaving them until clotted or early signs if infection. Especially in particularly hard sticks.

We also don't like to just start centrals on people unless they have terrible vasculature or are going to need long term vesicants and what not. Risk if infection and other complications with centrals outweighs the PIV site changes to most of our docs.

Share this post


Link to post
Share on other sites
I work at a hospital where we sometimes end up with patients for weeks and months. I've taken to tracking my IVs and how long they last.

I had one that was at 21 days when the patient was discharged and another at 27 days at discharge. Right now I have one that's at 40 days and counting...

What's the longest that you've had a PIV line last?

Is this supposed to be a joke? What country do you live in? A peripheral IV for 40 days?!?

Share this post


Link to post
Share on other sites
  • Recently Browsing   0 members

    No registered users viewing this page.

×