Best Practice is Changing Peripheral IVs Only When Clinically Indicated; Why are Hospitals' Policies Outdated?
You have just received a new patient from the ER that was brought in by EMS. You notice the patient has an IV (intravenous catheter for medication administration) that was a field stick, meaning the EMTs and Paramedics inserted it, what are you supposed to do? Most hospital policies require that you remove the field stick within the first 24 hours of admission, preferably as soon as the patient walks into the hospital, and a new IV started.
This is because hospitals cannot guarantee if aseptic techniques were used by the field responders to start the initial IV, while inside the hospital they can hold you accountable for following their own protocols and competency training, understandable.
As for IV initiated inside the hospital also has criteria to be held by. Most hospitals follow the 96-hour protocol for IV removal, meaning after 4 days you must discontinue the IV and start a new stick (some hospitals follow a 72 hour IV protocol).
I have had many nurses tell me that the IV expired, this is not true, the catheter that is advanced does not expire after 96 hours. Based on new research (many not that new) shows that there is no additional benefit for removing IV catheters after 96 hours or less. According to a study published by the CDC in 2011, the rate of infections, phlebitis, infiltration is not significant enough to require that patients receive a new IV every 96 hours, and the CDC recommends that an IV be replaced only based on clinical indication such as phlebitis, infiltration, occlusion, accidental removal, or suspected infection related to the catheter.
The Infusion Nurse Society has revised their guidelines as well, stating that there is no benefit in changing peripheral IV catheters every 72-96 hours. Keeping the occlusive dressing clean, dry and intact and maintaining strict supervision and assessing for signs of complications and only changing the IV when clinically indicated and changing only the dressing every 96 hours is the new guideline passed forth by the INS.
As a nurse, I like to practice as safe, efficient, time and cost effective. Many studies have concluded that clinically indicated IV removal and replacement, rather than time sensitive, such as the 72-96 hours, can be recommended and practiced without increased rates of phlebitis or other complications. Clinically indicated IV replacement, and leaving a catheter in for entire hospital stay can decrease cost and improve patient satisfaction. Some hospitals have chosen to extend their IV replacement window to 7 days.
Field sticks, in my opinion, should be removed immediately (as soon as possible), because aseptic technique can not be enforced, but in hospitals IV starts, the catheters can be left for longer than 3-4 days, as long as the dressing is kept clean, dry and intact and nurses continue to monitor for any signs of complications. A large-scale study published in the Lancet in 2012, showed that replacing peripheral IV when clinically indicated did not result in an increase in phlebitis compared with replacing them every 72 to 96 hours, the current policy at most hospitals states. Switching to an “as indicated” policy could prevent many unnecessarily invasive, uncomfortable IV sticks for patients and could lead to huge potential cost savings since it is estimated that 200 million catheters are inserted annually nationwide.
As long as nurses are being careful and complying with aseptic techniques during IV insertion, and keeping the dressing clean, dry and intact and changing the dressing as needed there should be no need to change the catheters every 4 days, saving in the costs and improving patient satisfaction and outcome.
The Dude Nurse
Klaus Campos, BSN-RN