What's the Recommendation for Flushing Practice to Keep a PIVC Patent?
There are two important aspects to consider regarding flushing practice of a peripheral intravenous catheter (PIVC): frequency and technique.
Frequency
Flush immediately before and after every infusion.
For continuous infusions, flush via the administration set using a syringe at the injection port closest to the patient.
If the PIVC isn’t in use but still clinically indicated, check patency and flush every 24 hours.
Technique
NOTE: Use aseptic technique for the steps below.
Use the correct connection sequence based on add-ons (i.e. extension set with/without clamp, positive/negative displacement needleless connector). Refer to manufacturer for best practice.
Use a syringe with a 10 mL barrel (e.g. 10 mL syringe or 5 mL prefilled syringe in a 10 mL barrel) filled with 0.9% sodium chloride. This provides a safe injection pressure to reduce risk of vessel damage. If available, use a prefilled saline syringe as it reduces risk of infection and device failure. NOTE: Smaller barrel syringes exert higher injection pressures and are linked to vessel damage and premature device failure.
Flush the PIVC using gentle pulsatile motions to increase debris clearance from the catheter. Use enough volume to flush the PIVC and any add-ons. For PPN or lipid infusions, flush with an additional 10 mL to reduce infection risk.
Do not bottom out the syringe plunger as this results in blood reflux into the catheter.
Use the correct disconnection sequence based on add-ons (i.e. extension set with/without clamp, positive/negative displacement needleless connector). Refer to manufacturer for best practice.
References
Australian Commission on Safety and Quality in Health Care. (2021). Management of Peripheral Intravenous Catheters Clinical Care Standard.
Cancer Nurses Society of Australia. (2024). CNSA Vascular Access Devices: Evidence-Based Clinical Practice Guidelines. https://www.cnsa.org.au/practiceresources/vascular-access-resources
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: 19/09/2024
