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A Lesson from the Evidence: Replacing Emergently Placed Peripheral IVs
When a patient has a peripheral line placed in an emergency, whether it is out in the field or in an acute care setting, the intravenous infusion device is discontinued and replaced as soon as possible and certainly within 48 hours (CDC, 2002). This policy from the Centers for Disease Control  and Prevention has been the mainstay of our practice for many years, but is it still best practice? The Infusion Nurses Society thinks differently and recommends that without signs of catheter-related complications, pre-hospital peripheral catheters should not be routinely replaced (Mermel, Farr, & Sheretz. 2001).

A study published in the Journal of Trauma Nursing, Assessing Guidelines for the Discontinuation of Prehospital Peripheral Intravenous Catheter, examined this issue.Their study was a descriptive, archival, retrospective study that reviewed 365 trauma patients, over the age of 17 years, who were admited to an urban level 1 trauma center. The results demonstrated that less than 1% of the patients had complications related to a prehospital peripheral intravenous catheter being left in place longer than 48 hours (Clemin, Heldt, & Jones, et. al., 2012).

What are the implications for practice? Although one study should not change practice, there is evidence in the literature that the current policy needs to be further investigated through research and revised. I encourage all of you to base your practice on evidence and recognize that evidence is not stationary, it evolves every day. What was evidence-based practice 10 years ago, may not be best practice today.

References:
Centers for Diseas control and Prevention, 2002.
Guidelines for the prevention of intravascular catheter-related infections. MMWR,  (5)1, 1-29.

Clemin, Heldt, & Jones, et. al., 2012.
Assessing Guidelines for the Discontinuation of Prehospital Peripheral Intravenous CathetersJournal of Trauma Nursing, (19)1, 46-49.

Mermel, L., Farr, B., & Sherentz, R. et. al., 2001.
Guidelines for the management of intravascular catheter-related infections
. Journal of Infusion Nursing, (24)3, 180-205.

Submitted by:
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC
Chief Nurse and Publisher
Wolters Kluwer Health / Lippincott Williams & Wilkins / Ovid Technologies

Posted by Lisa Morris Bonsall on 4/9/2012 9:56:00 AM with 2 comments
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