The following article features coverage from ONS Bridge 2020. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

 

A literature review performed with the aim of determining the optimal timing for replacing peripherally inserted venous catheters (PIVs) in hospitalized patients did not support timed PIV rotation. These findings were presented on the Oncology Nursing Society (ONS) Bridge, a virtual conference.1

Although PIVs are commonly inserted in hospitalized patients, including patients with cancer, the latter group is frequently characterized by older age as well as comorbidities that may make PIV placement more difficult.


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Use of PIVs has been associated with increased risks of phlebitis and infection, and these catheters are also susceptible to occlusion as well as infiltration involving leakage of the intravenous solution from the vein into the surrounding tissue.

To mitigate some of these risks, some hospitals mandate that PIVs be replaced on a set schedule, such as every 96 hours, independent of whether PIV-related complications are present. However, other institutions have policies supporting replacement according to clinical indications.

With the aim of comparing the impact of these 2 policies on the incidence of PIV-associated adverse effects, Cora Frantz, MSN, OCN, an oncology nurse at Sibley Memorial Hospital in Washington DC, a member of Johns Hopkins Medicine, conducted a literature review on the topic.

Included in the final analysis were 8 recently published articles, including a Cochrane review on the topic published in 2015 that was based on the results of 7 randomized clinical trials.2

A key finding was that there were no significant differences in the incidences of infection, phlebitis, and occlusion when PIV replacement was performed based on catheter dwelling time or the occurrence of clinical indications supporting PIV rotation.

Regarding infiltration, Ms Frantz commented that there were some mixed findings in that some of the articles in the Cochrane review that addressed this issue did find a tendency for more infiltration with longer-dwelling PIVs. However, she explained that infiltration would also be a clinical indication to rotate the PIV.

She further noted that a policy of PIV replacement only when clinically indicated is likely to result in a reduction of direct and indirect costs related to this procedure.

“Based on all of this evidence, it is best practice to rotate PIV sites based on clinical indications rather than on a set routine rotation schedule,” stated Ms Frantz in summarizing the overall results of this literature review.

This statement is consistent with the Infusion Therapy Standards of Practice published by the Infusion Nursing Society, which recommend against replacement of vascular access devices solely on the basis of dwell time.3

References

1. Frantz C. Clinically indicated replacement versus routine replacement of peripherally intravenous catheters: Review, recommendations, and policy change. Presented at: ONS Bridge; September 8-17, 2020. Accessed September 11, 2020. https://ons.confex.com/ons/2020/qi/eposter.cgi?eposterid=796

2. Webster J, Osborne S, Rickard CM, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2015;(8):CD007798. doi:10.1002/14651858.CD007798.pub4

3. Gorski L. The 2016 infusion therapy standards of practice. Home Healthc Now. 2017;35(1):10-18. doi:10.1097/NHH.0000000000000481