All,
Please tell me if I am missing something with the new INS standards. Do "we" not have a recommended dwell time of 72 hours for placement in an adult. I know INS used to want facilities to "prove" that their phlebitis rates were low to be able to have a 72 hour dwell, and if it wasn't proven, then short term peripheral IV catheters should have been changed q 48 h.
I cannot, however, find anything in the new standards about dwell time. Am I looking in the wrong place?
TY
You are not missing anything, but the published evidence has radically changed the approach to this issue. First of all, short peripheral catheters are no longer defined as less than 3 inches with midlines being longer than 3 inches. The committee could find no evidence to support this division by device length. Second, there is now several well-designed studies that have shown that allowing a short peripheral catheter to reside until it is clinically indicated to remove it produces the same outcomes as those that are automatically removed and restarted at a certain time period. Please read INS Standarrd #44 carefullly for all the statements along with attention to the references we included. So each organization must make there own decisions about how they want to address this. I would suggest writing it as a practice guideline. An automatic time limit for dwell of any catheter should never be written as a policy because to takes away the opportunity for the nurse to make patient-specific decisions about care. If it is a policy there can be no variation. Policies should be regarded as nonmodifiable and nonnegotiable and can only be altered by going through the proper committes. If Joint commission finds that your facility is not following such a policy, you will receive a negative review. In the practice guideline, you can suggest a time limit (e.g. 96 hours) but then provide criteria for what should be included in the assessment to allow it to remain for a longer period. That would be my approach. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ok, I see this thread www.iv-therapy.net/node/5307 is over here now. I just want to clarify some numbers or dates here (please correct me if I'm wrong). It was 2002 that the CDC allowed the (then) recommended PIV dwell time to be extended to 96hrs (if phlebitis was kept below 5%) from 72hours. INS adopted that recommendation in the 2006 standards. Now the INS has made a decision (2011 INS standards) independently of the CDC to change a mandatory 72-96 hour PIV site rotation to no time frame dwell time. Unfortunately the CDC found the evidence for (the always known pediatric standard) no routine PIV changes "inconclusive"
KUDOS to the INS for reviewing the literature and changing the standard independently of the CDC !!!
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Not quite the sequence of events but thanks for the kudos to INS and the standards committee. INS writes standards and CDC writes guidelines. In a standard, lawyers have always advised that one can not write a range of time such as 72 to 96 hours. In the 2002 CDC document, their range was 72 to 96 hours. In the 2006 INS standards, we did not find enough evidence to extend the standard from 72 h to 96 h. Remember that standards must be written for all settings. So we write for the lowest common denominator, or the smallest facility with the least experienced nurses. We did not feel it was safe to extend it to 96 h at that time.
With the publication of newer well designed randomized trials, we were able to write the standard as you now see it. Studies have shown the same outcomes for catheters routinely changed at a specific time interval vs those changed when clinically indicated.
CDC and INS collaborated on this issue. Their new document is due to be released any day now and I do not know what their decision was about this issue. So wait to get their new set of guidelines. Given the process we set with the ranking system in the new INS standards and the new evidence, we felt that our current approach was the best for the INS document. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
"2006 INS standards, we did not find enough evidence to extend the standard from 72 h to 96 h."
Thank you Lynn for the clairification, it was a CDC guideline only for a 96h site change.
"CDC and INS collaborated on this issue. Their new document is due to be released any day now and I do not know what their decision was about this issue. So wait to get their new set of guidelines. "
Ok. Then there is hope. I was going on their preliminary release.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
"2006 INS standards, we did not find enough evidence to extend the standard from 72 h to 96 h."
Thank you Lynn for the clairification, it was a CDC guideline only for a 96h site change.
"CDC and INS collaborated on this issue. Their new document is due to be released any day now and I do not know what their decision was about this issue. So wait to get their new set of guidelines. "
Ok. Then there is hope. I was going on their preliminary release.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.