What is the recommended duration of intravenous (IV) cannulation in long-term care facilities?

Recommended Duration of Intravenous Cannulation in Long-Term Care Facilities

Peripheral venous catheters should be replaced every 72-96 hours in adults in long-term care facilities to prevent phlebitis and related complications. 1

Evidence-Based Guidelines for IV Cannulation Duration

Peripheral Venous Catheters

• Replace peripheral venous catheters at least every 72-96 hours in adults 1
• For pediatric patients, leave peripheral venous catheters in place until IV therapy is completed, unless complications (e.g., phlebitis and infiltration) occur 1
• When catheters are inserted during medical emergencies with compromised aseptic technique, replace all catheters as soon as possible and within 48 hours 1

Duration Based on Therapy Length

The recommended catheter type varies based on anticipated therapy duration:

• For therapy lasting 6-14 days: Midline catheter 2
• For therapy lasting 15-30 days: PICC line or non-tunneled central venous catheter 2
• For therapy lasting ≥31 days: Tunneled central venous catheter or implanted port 2

Special Considerations for Long-Term Care

1. Midline catheters:

   • Do not routinely replace to reduce infection risk 2
   • Remove when no longer clinically necessary or when complications develop 2
   • Appropriate for solutions with pH between 5-9 and osmolarity less than 500 mOsm/L 2
   • Consider for IV therapy expected to exceed 6 days 1

2. Central venous catheters:

   • Do not routinely replace central venous catheters solely to reduce infection rates 1
   • For patients with advanced chronic kidney disease (CKD stage 3b or greater, eGFR <45 mL/min), tunneled small-bore central catheters are recommended to preserve peripheral veins 2

Administration Sets and Equipment Replacement

• Replace administration sets, including secondary sets and add-on devices, no more frequently than every 72 hours, unless catheter-related infection is suspected 1
• Replace tubing used for blood, blood products, or lipid emulsions within 24 hours of initiating the infusion 1
• Change needleless components at least as frequently as the administration set 1
• Change caps no more frequently than every 72 hours or according to manufacturers' recommendations 1

Emerging Evidence on Clinically-Indicated Replacement

Recent research suggests that clinically-indicated replacement (rather than routine replacement) of peripheral IV catheters may be a safe alternative:

• A Cochrane review found no clear difference in rates of catheter-related bloodstream infection, thrombophlebitis, all-cause bloodstream infection, or mortality between clinically indicated or routine replacement of PIVCs 3
• Clinically indicated removal may reduce device-related costs by approximately AUD 7.00 per patient compared with routine removal 3
• However, infiltration and catheter blockage rates were found to be lower with routine replacement 3

Best Practices for Infection Prevention

1. Site assessment:

   • Evaluate the catheter insertion site daily by palpation through the dressing to detect tenderness 1
   • Visually inspect the site if a transparent dressing is used 1
   • Remove the catheter if signs of phlebitis (warmth, tenderness, erythema, palpable venous cord), infection, or malfunction develop 1

2. Antiseptic techniques:

   • Clean injection ports with 70% alcohol or an iodophor before accessing the system 1
   • Cap all stopcocks when not in use 1
   • Minimize contamination risk by accessing ports only with sterile devices 1

Common Pitfalls and Caveats

• Routine replacement at 72-96 hours may be unnecessary if there are no signs of complications and if sites for venous access are limited 1
• Restarting catheters at 72 hours does not necessarily reduce the risk of complications in the next 24 hours compared to continuing with the original catheter 4
• A restarted catheter has a significantly higher risk of complication in its first 24 hours than an initial catheter 4
• Do not submerge catheters under water; showering should be permitted only if precautions are taken to protect the catheter and connecting device with an impermeable cover 1

While the CDC guidelines recommend routine replacement every 72-96 hours 1, healthcare organizations may consider a policy of changing catheters only when clinically indicated, which could provide cost savings and reduce patient discomfort without increasing infection rates 3. However, this approach requires vigilant monitoring for signs of complications.