Phlebitis and Peripheral Intravenous Line Dwell time
Abstract: Many health care institutions have policies which mandate the discontinuation and restarting of peripheral IVs at seventy-two hours. The aim of these policies is to prevent phlebitis. The purpose of this paper is to examine the evidence for this practice to determine if is necessary. The PICO Question is: is there any difference in the rate of phlebitis when an IV is allowed to remain longer than 72 hours if there are no problems; or discontinued after 72 hours and restarted. Six research studies were found using CINAHL and Medline using the key words “phlebitis” and “peripheral IVs”. The articles were from around the world and reflected both sides of the issue. These studies show that the rate of phlebitis and other complications is not significantly different in a peripheral IV, which was changed at a prescribed time and an IV which was changed only when symptomatic. More research needs to be done, and the dwell time of an individual peripheral IV is not the largest cause of complications.
Stetler Phase I. Preparation Many health care institutions have policies concerning peripheral intravenous lines (IVs) and the length of time that the IVs are to remain in place. Usually the policies mandate that peripheral IVs be discontinued and restarted after 72 hours, even if the IV site is healthy and there are no signs or symptoms of complications. This increases patient discomfort, medical costs, nursing time and may be unnecessary. The purpose of this paper is to examine the scientific research that concerning the policy of elective IV change. Is there any difference in the rate of phlebitis when an IV is allowed to remain longer than 72 hours if there are no problems; or discontinued after 72 hours and restarted. The standard of the Infusion Nurses Society (INS) states that IV sites should be changed every 72 hours (INS, 2006). The INS standard is used by many hospitals and home health care agencies. The policies have been developed to prevent phlebitis due to an IV that has remained in place for an extended period of time and has become infected. The Centers for Disease Control (CDC) also has guidelines for prevention of phlebitis that recommend changing peripheral IV catheters at 72 to 96 hours (CDC, 2002). The requirement to discontinue and restart peripheral IVs is relevant in inpatient care areas but more so in home health care, where the patient has been allowed to stay at home or to return home and needs further IV therapy. These patients often do not have veins which are easy to cannulate, they may live in remote areas which are difficult to travel to, and often there is one home health care nurse available after hours who may not be able to restart an IV after it has been discontinued due to small fragile veins. This causes more pain and trauma to the patient and is costly and time consuming. It can also cause a delay in medication being administered. If the patient lives in a rural or mountain area the trip to a local hospital, where another person could attempt to replace the IV, may be many miles away. Even if the patient lives in the city, a trip to the hospital may take hours of time and result in discomfort and added costs. If a patient develops phlebitis he can be taught the signs and symptoms and he can be instructed to call the nurse on call, who can make a visit and change the IV as needed. The nursing theory used as a framework to examine this problem was Levine’s conservation theory (Wills & McEwen 2002). Levine’s principle of conservation of structural integrity refers to maintaining or restoring the structure of the body preventing physical breakdown and promoting healing (Wills & McEwen, 2002). An IV has to pierce a patient’s skin to be placed into a vein and patients are fearful of this because it is a painful procedure....
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