What's Your Longest Lasting PIV?

Nurses General Nursing

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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?

We just transitioned to a "based on assessment/functionality" policy.

A lot of my patients get a central line though. I work neurosurgery in a trauma center. Most of our trauma patients (neuro or otherwise) get a CVC - possibly or likely needing pressors, mannitol, heparin, blood (a la Massive Tranfusion Protocol and/or given blood via a warmer or rapid infuser), etc. Most of our ECMO patients end up with central access too (adult, ped or neonatal). Sometimes they get it in the trauma bay, sometimes in the ICU, others in the OR. Patients who are non-traumas, non-emergencies who are expected to have an extended hospital course? Central line, especially difficult sticks. Some of our patients we know will have 2-3 operations, staged, as part of their admission - those get a central line. Procedures which are a high risk for air embolism? Yep, central line (could use a port on the central line to remove the air bubble and the patient and staff would be screwed without it if needed).

Specializes in Pediatrics, Pediatric Float, PICU, NICU.

In pediatric world, we leave them in as long as we can as long as they still function and show no signs of phlebitis or infiltration.

Specializes in Infusion Nursing, Home Health Infusion.

Muno is correct and if your institution has not changed their practice they are behind the times and not giving evidenced based IV care.I changed our policy as soon as INS put out their white paper on this and that was years ago.Change IV sites only if needed.

Specializes in Emergency, Telemetry, Transplant.
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.

My first job as a nurse, there was the 72 hr rule. Since 2010 or so, everywhere I have worked has the "leave it in til it goes bad" rule.

Having said that, 40 days for one PIV sounds like a lot. Then again, if it's a good line....

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

I work on the IV team and our policy is change the IV n 24 hours if it is an EMS start, otherwise change it in four days.

We do have patients refuse to have their IV restarted (I can't blame them, I would too if it looked and felt totally fine). The longest I have seen is maybe 7 days without it infiltrating or starting to get erythema or form cords.

Annie

I should clarify, on my unit we definitely keep it as long as it lasts. BUT I know for a fact I have not seen a PIV last 40 days, and at that point, a PICC should definitely be considered.

Specializes in Med-Tele; ED; ICU.
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.

Why would the facility subject the patient to the inherent risks of a central line when a peripheral line suffices?

Specializes in Med-Tele; ED; ICU.
Is this supposed to be a joke? What country do you live in? A peripheral IV for 40 days?!?

It's no joke at all.

I live in the US.

Why do you find this so shocking?

If the site remains asymptomatic and the line aspirates and flushes beautifully, why would you discontinue it barring some clear evidence that sustained access is detrimental to the patient?

When I started at my facility 7 years ago, the policy was to change adult lines every 96 hours. A few years back they changed it to replace as needed.

Specializes in Med-Tele; ED; ICU.

Based on the responses here and my personal experience, nurses should be examining their policies and advocating for research and possible changes in this area.

Over the 6 months that I've been tracking my lines, here's what I've seen:

... many lines lasting 10-15 days... most lines intact at discharge... most lines used for routine lab draws... two lines >20d at discharge... and this one at >40 days...

The vast majority (>90%) of these lines are 20g x 1.88" catheters placed by ultrasound guidance in larger, deeper vessels (5-10mm deep). Interestingly, two of the three were placed just proximal and medial to the AC.

Why would the facility subject the patient to the inherent risks of a central line when a peripheral line suffices?

I love your original question and the responses. I did not know the new studies about leaving IV's in more then 3 days, but I have been working out patient surgery for a long time.

However a PICC is "peripherally" inserted, often in the antecubital fossa, it is not a "central line." They can remain 6 - 12 months, but that was my quick Google search, I may not be up to date on PICC's either? But even with that I guess if the IV is working fine why bother?

Specializes in Med-Tele; ED; ICU.
I love your original question and the responses. I did not know the new studies about leaving IV's in more then 3 days, but I have been working out patient surgery for a long time.

However a PICC is "peripherally" inserted, often in the antecubital fossa, it is not a "central line." They can remain 6 - 12 months, but that was my quick Google search, I may not be up to date on PICC's either? But even with that I guess if the IV is working fine why bother?

Yeah, "PI" means "peripherally inserted" but "CC" means "central catheter" which terminates at SVC/RA interface... and is absolutely a "central line," with all the risks associated with them.

PICC lines are not just a super long PIV that can last for months and they certainly are not benign nor risk-free... blood clots and infections being the big ones though accumulated damage to the vasculature is also significant over time.

PICC lines should only be used when you need a central line or have no other peripheral options. My experience is that they are too often used for convenience.

The 3-4 days things is a myth, I have never seen any actual evidence that it benefits a patient to rotate IV sites unless there is infiltration or obvious infection. 40 days is bit long though and I would question why someone would need IV access for that length of time. If it was for antibiotic therapy (discitis, osteomyelitis etc) a PICC should really be inserted and the patient d/c for outpatient infusions.

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