Now that many of us are changing PIVs as clinically indicated, I am interested in finding out how other hospitals are educating their staff on care and maintenance of PIVs that are lasting longer than 7 days. (Dressing changes, extension set changes, cap changes, etc.)
Good question. I am curious about how many PIV actually dwell that long. Do you have any data to share? 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
In peds it has always been the practice to change PIVs when clinically indicated. Although unusual, I have seen PIVs that have lasted two weeks.
Generally we do not change the dressing unless it is compromised. Often when manipulating a PIV for dressing changes or other reasons, it becomes problematic shortly thereafter..i.e. leakage at the insertion site being the most common but also accidental dislodgement during manipulation is a concern.
Likewise any extension tubing (t-connector) is considered part of the catheter and not changed unless compromised for the same reasons.
Angela confirmed what I have also seen when attempting to change the extension set and dressing on a PIV. Also think about the types of PIVs with a permanently attached extension set like BD Nexivia. No way to change that extension set and that catheter could dwell for an extended time also. I firmly believe that all PIVs need an extension set attached but also agree that they should be attached at insertion and remain until the catheter is removed. 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
Hi Lynn, I'm just seeking clarification on this point you made. If the extension set is not permanently attached to the catheter (as in BD Nexiva, which I love), how can we not consider the extension set part of the administration set that needs to be changed at policy-prescribed intervals? I agree that changing that extension set manipulates the catheter and creates an opportunity for CRBSIs, but how do we write a policy that specifically draws the line at a specific point in the infusion circuit that sometimes includes the extension set and sometimes only includes up-to the extension set? Is the extension set mentioned in INS Standard 43.3 different from the tube you attach to the peripheral IV catheter hub? Thank you so much for sharing your knowledge! Keith
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Good points. I don't have any firm data on the lifespan of PIV's since making the change, but we are definately seeing a good number lasting over 7 days.
I had 1 PIV that lasted the entire 2 weeks of therapy and when I DC'd it you would have never guessed there had been an IV there. Another CRNI friend told me he had one last for a 21 day treatment with no complications. My history in (LTC) long term care came into play when I had the 2 week therapy and the pt. was in their 70's. In LTC when you get a PIV started in an elder, you had to keep it in as long as there were no complications because it was so difficult to get them started in most elders. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC