What is the Recommended Frequency for Changing a Peripheral IV Catheter?

Peripheral intravenous catheters (PIVC) should only be removed when clinically indicated. Clinically indicated means any sign of device-related complication (e.g. pain at the site of insertion, redness, swelling) or the device is no longer required. 

Routine replacement of PIVCs is no longer recommended as it may lead to difficulties with re-insertion, potential damage to viable veins, patient discomfort, an increased risk of healthcare worker injuries, and higher healthcare costs.

Exceptions

• Certain patient populations may be appropriate for routine PIVC replacement (e.g. immunocompromised). Clinical judgement is required for every patient when making this decision. For this population, routine replacement of PIVC should occur between 72-96 hours. 
• Non-aseptic Insertions: It is not uncommon for the clinical need to insert a PIVC with non-aseptic technique (e.g. insertion without skin preparation). This is not ideal, but in the real world is often required to save a life. When a PIVC is inserted with a breach in aseptic technique (e.g. medical emergency), label the PIVC as non-aseptic and document. This device should be replaced within 24-48 hours or sooner if clinically appropriate.
• Site of insertion: If the PIVC is placed in the hand, external jugular, internal jugular, lower extremities or site of flexion (e.g. antecubital fossa), replace the PIVC within 24-48 hours, or sooner if clinically appropriate.
   

Device Monitoring
Identification of complications relies heavily on device monitoring by clinical staff. This should occur at least daily, but more frequently depending on:

• Setting (in hospital every 4 hours minimum, out of hospital every interaction)
• Patient factors (increased monitoring based upon cognitive status, patient age, condition)
• Infusate (more frequently for vesicant medications or high volume).

Device assessment should consider if the PIVC is still needed, still working, any complications, dressing integrity, and patient preference. Always document the device assessment and any actions taken.
 

Tips for Increased Dwell Time

1. Consider if a PIVC is the best device based upon patient needs. Consider length and type of treatment, risk of premature device failure. PIVCs are intended for short treatment - less than 7 days.
2. Utilise ultrasound or other visualisation technologies to identify and insert the PIVC.
3. Dedicate time to ensuring that the first attempt is the best attempt. 
4. Utilise large, straight forearm veins as first option, where possible.
5. Ensure adequate securement of device using a bordered transparent dressing.
6. Regularly flush and lock the PIVC with preservative-free 0.9% sodium chloride.
7. Utilise extension sets (integrated or add on)

References

ACSQHC (2021). Management of Peripheral Intravenous Catheters Clinical Care Standard | Australian Commission on Safety and Quality in Health Care

I-DECIDED assessment and decision tool (avatargroup.org.au)

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., & Ong, J. (2024). Infusion therapy standards of practice. Journal of Infusion Nursing, 47(1S), S1-S285. 

Pittiruti, M., Van Boxtel, T., Scoppettuolo, G., Carr, P., Konstantinou, E., Ortiz Miluy, G., Lamperti, M., Goossens, G. A., Simcock, L., Dupont, C., Inwood, S., Bertoglio, S., Nicholson, J., Pinelli, F., & Pepe, G. (2023). European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. The Journal of Vascular Access, 24(1), 165-182. https://doi.org/10.1177/11297298211023274 

World Health Organization. (2024). Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters. Part I: peripheral catheters. World Health Organization.

Last Updated on: 09/09/2024