Do INS Standards address the issue of when to change PIV sites that are inserted by either an outside facility or by the EMS responders prior to arriving at the hospital? Currently, it is our policy to change out a squad PIV start within 24 hours after admission to the hospital. Any feedback would be appreciated!
Vickie
The statement from INS and CDC are almost the same.
INS Standard statement - VADs placed in an emergency situation shall be replaced as soon as possible and not later than 48 hours.
CDC - When adherence to aseptic technique cannot be ensured (i.e catheters inserted during a medical emergency), replace the catheter as soon as possible, i.e, within 48 hours [37,73–76]. Category IB
Neither of these statements include anything about where the patient is located when the catheter is inserted, who inserted it, or what type of catheter. Therefore, my interpretation is that these statements apply to all healthcare settings and not just those started outside of your facility or by EMS. It includes all situations where the conditions are emergent and aspetic technique can not be used. It applies to all personnel and to all types of VADs, including both peripheral and central lines inserted in emergent conditions.
This demands that the condition under which all catheters were started be included in hand-off communications so that the ER nurses know the conditions and can pass that information on to ICU when the paitent is transferred. Or the med-surg nurses can pass the information on to ICU when a patient is transferred after a code situation.
We need to look at the conditions and not where the patient actually was when the catheter was inserted. If you do not have that information, I would say error on the site of caution and remove it ASAP or at least within 48 hours. I can also add that this has been an issue in lawsuits involving catheter complications. 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
Our institution follows the quoted guidelines for emergency access. With respect to other hospital PIV access, we HAD been changing all the lines within 24 hrs of the pt arrival. However, under the principle of vein preservation, we modified the practice to leave perfectly functional, clean, dry, intact, uncompromised PIVs in place.
Dave B
David Bruce RN
Thank you for the feedback so far. it is very helpful and appreciated.
Vickie Teresinski, RN, CRNI
We follow the guidelines. If the line is from another hospital and is dated and timed with clinical documentation sent with the patient, we will allow it to remain in place. Any line started "in the field" is to be changed within 24 hours of arrival.