Asante adopts new evidence-based IV guidelines
The Peripheral Intravenous Management (Adult) #400-PCS-NURS-0399 policy has been updated based on the Infusion Nurse Society 2021 guidelines:
- Peripheral IVs in adult patients will no longer be changed based on dwell time (previously every 96 hours). They will now be changed as clinically indicated (occlusion, infiltration, phlebitis, extravasation, etc.).
- Exception: IVs placed under suboptimal technique (e.g. field starts) should still be replaced within 24 hours.
- Because peripheral IVs will no longer be changed routinely, peripheral IV assessments on adult patients are now required every four hours as opposed to every shift.
These welcome changes support evidence-based practice and they do not replace the need to critically think. Recently, our Asante Hospital-Acquired Infection Tiger team reviewed one case in that revealed an opportunity to improve our practices.
A 33-year-old patient was admitted for acute kidney injury and urinary retention. Sixteen days into their stay, the patient developed a fever and chills. A blood culture revealed the presence of E coli. A chart review showed that the patient had a central line for administration of antibiotics and a peripheral IV that stayed in place for more than 21 days. The IV remained in place even after the infection was identified, putting the patient at risk of further complications.
This case demonstrates the importance of assessment and early intervention to prevent patient harm. As Asante moves away from routinely changing peripheral IVs based on dwell time, it is necessary to perform more frequent assessments to identify complications and intervene early on. Because of this, nurses will soon receive an education module regarding IV assessment, IV management and complication interventions.
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