What are the guidelines for prescribing an intravenous (IV) starter kit?

Guidelines for Prescribing an Intravenous (IV) Starter Kit

When prescribing an IV starter kit, follow CDC guidelines that recommend selecting catheters based on intended purpose, duration of use, and known complication risks, with trained personnel designated for insertion and maintenance of intravascular catheters. 1

Catheter Selection and Insertion Site

• Select appropriate catheter type based on therapy duration:

  • Short-term therapy (≤5 days): Standard peripheral IV catheter 1, 2
  • Medium-term therapy (6-14 days): Midline catheter 1, 2
  • Longer-term therapy (≥15 days): PICC or central venous catheter 2

• Avoid steel needles for administering fluids or medications that might cause tissue necrosis if extravasation occurs 1

• Insertion site priorities:

  • Adults: Use upper extremity sites rather than lower extremity sites 1
  • Pediatric patients: Hand, dorsum of foot, or scalp are acceptable 1

Maintenance and Replacement Guidelines

• Replace peripheral venous catheters:

  • Every 72-96 hours in adults to prevent phlebitis 1, 2
  • In children, only when complications occur or therapy is complete 1
  • Replace catheters inserted during emergencies within 48 hours 1

• Administration set replacement schedule:

  • Standard IV tubing: No more frequently than every 72 hours 1
  • Blood/blood products/lipid emulsion tubing: Within 24 hours of starting infusion 1
  • Propofol infusion tubing: Every 6-12 hours per manufacturer's recommendation 1

Infection Prevention Measures

• Site care:

  • Evaluate catheter insertion site daily by palpation through dressing 1, 2
  • Visually inspect if transparent dressing is used 2
  • Clean injection ports with 70% alcohol or iodophor before access 1
  • Cap all stopcocks when not in use 1

• Fluid administration time limits:

  • Lipid-containing solutions: Complete within 24 hours 1
  • Lipid emulsions alone: Complete within 12 hours (24 hours if volume considerations require) 1
  • Blood/blood products: Complete within 4 hours 1

Special Considerations

• For patients with advanced chronic kidney disease (CKD stage 3b or greater, eGFR <45 mL/min), consider tunneled small-bore central catheters instead of midline catheters to preserve peripheral veins 2

• For patients with history of IV drug use:

  • For short-term therapy, peripheral IV catheters with ultrasound guidance may be safer than PICC placement 2
  • Implement enhanced monitoring protocols if PICC is necessary 2

Common Pitfalls to Avoid

1. Incompatible components: Ensure all components of the system are compatible to minimize leaks and breaks 1

2. Contamination risk: Only access ports with sterile devices and proper antiseptic technique 1

3. Inappropriate catheter selection: Using steel needles for medications that could cause tissue necrosis if extravasation occurs 1

4. Submerging catheters: Do not submerge catheters under water; protect with impermeable cover during showering 1

5. Routine filter use: Do not use filters routinely for infection control purposes 1

By following these evidence-based guidelines when prescribing IV starter kits, you can minimize complications such as phlebitis, infection, and catheter failure, ultimately improving patient outcomes and reducing morbidity and mortality associated with IV therapy.