In the past, we have routinely replaced peripheral IV catheters every 48-72hours. Since INS 2011 Standard for Infusion Nursing revised it to site rotation based on clinical indications, PIV site assessment is even more important now. So how frequent should you assess the patient’s peripheral IV site?
According to the latest Position Paper from the Infusion Nurses Society:
When an infusion is running (whether continuous or intermittent*), peripheral IV catheter sites should be routinely assessed for redness, tenderness, swelling, drainage,and/or the presence of paresthesias, numbness, or tingling at the specified frequency listed below. Assessment should minimally include visual assessment, palpation, and subjective information from the patient. If there is tenderness at the site, the dressing may be removed to more carefully visualize the site:
a. At least every 4 hours
- Patients who are receiving nonirritant/nonvesicant infusions and who are alert and oriented and who are able to notify the nurse of any signs of problems such as pain, swelling, or redness at the site.
b. At least every 1 to 2 hours
- Critically ill patients
- Adult patients who have cognitive/sensory deficits or who are receiving sedative-type medications and are unable to notify the nurse of any symptoms
- Catheters placed in a high-risk location (eg, external jugular, area of flexion)
c. At least every hour
- Neonatal patients
- Pediatric patients
d. More frequently: every 5 to 10 minutes
- Patients receiving intermittent infusions of vesicants
• The nurse should advocate for central vascular access administration of vesicant medications whenever possible. The peripheral infusion of vesicant agents should be limited to less than 30 to 60 minutes.
• In addition to visual assessment of the site, a blood return should be verified every 5 to 10 minutes during the infusion
2. Patients receiving infusions of vasoconstrictor agents
• The nurse should advocate for central vascular access administration of vasoconstrictor agents whenever possible as these agents can cause severe tissue necrosis with extravasation.
With every home/outpatient visit
- For patients receiving peripheral infusions at home as overseen by home care or outpatient nurses
- Patient and family education should include:
- What to look for: redness, tenderness, swelling, or site drainage
- To check the site at least every 4 hours during waking hours
- Ways to protect the site during sleep and activities
- How to stop the infusion if signs/symptoms occur
- To promptly report to the nurse
- The organization’s 24-hour contact telephone numbers
For all patients who have a locked peripheral IV catheter for intermittent infusions, the site should be assessed with every catheter access/infusion or at a minimum of twice per day.
Temperature should be checked at a frequency according to organizational policy/procedure and more often based on nursing judgment.
So there it is…..does your organization/facility have a policy and procedure on this? How often do you really check PIV sites?
Let me know what you think…share your thoughts/comments here or on Twitter @infusionnurse.