What is the recommended duration for an intravenous (IV) line to stay in place?

Duration of Intravenous Catheter Placement

Peripheral IV catheters do not need routine replacement and should be removed only when clinically indicated, as routine replacement every 72-96 hours provides no infection benefit and increases costs and patient discomfort.

Peripheral Intravenous Catheters

Recommended Duration

• Remove peripheral IV catheters based on clinical indication only rather than at fixed time intervals 1, 2
• There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce infection or phlebitis risk in adults, though this represents a maximum rather than mandatory replacement interval 1
• In children, replace peripheral catheters only when clinically indicated 1

Evidence Supporting Extended Use

• Randomized controlled trial data demonstrate that routine replacement every 3 days versus removal on clinical indication showed identical complication rates (68 vs 66 per 1,000 catheter-days, P=0.86) 2
• Clinically indicated removal allows 50% of patients to complete IV therapy with a single catheter versus only 20% with routine replacement 2
• Extending replacement intervals from 48-72 hours to 72-96 hours is not a risk factor for local catheter infection 3
• Closed-system peripheral catheters can safely remain in place for up to 144 hours when removed on clinical indication, with 29% reduction in phlebitis rates compared to open-system catheters 4

Clinical Indications for Removal

Remove peripheral IV catheters when 1:

• Signs of phlebitis develop (pain, tenderness, erythema, warmth, palpable cord)
• Infiltration or extravasation occurs
• Catheter becomes occluded or malfunctions
• Patient develops fever without obvious source
• IV access is no longer needed

Midline Catheters

• Replace midline catheters only when there is a specific clinical indication 1
• Appropriate for 6-14 days of peripherally compatible infusates in general medical patients 1

Central Venous Catheters (CVCs) and PICCs

Non-Tunneled CVCs and PICCs

• Do not routinely replace CVCs, PICCs, or pulmonary artery catheters to prevent catheter-related infections 1
• Do not remove CVCs or PICCs based on fever alone; use clinical judgment regarding infection evidence elsewhere 1
• Internal jugular non-cuffed catheters should not be used for more than 1 week due to exponentially increasing infection risk 5
• Femoral catheters should not remain in place longer than 5 days and should only be used in bed-bound patients with good exit-site care 5

Tunneled, Cuffed Catheters

• Preferred for longer durations of hemodialysis therapy over non-cuffed catheters due to significantly lower infection rates 5
• Can provide access over a period of months 5
• Non-cuffed catheter infection rates are more than 5 times greater with internal jugular catheters and almost 7 times greater with femoral catheters compared to tunneled cuffed catheters 5

Site-Specific Considerations

• Right internal jugular vein is preferred for catheter placement due to direct route to caval-atrial junction and lower complication risk 5
• Avoid subclavian vein catheterization due to risk of central venous stenosis, particularly in patients who may need permanent vascular access 5

Administration Sets and Tubing

Standard Crystalloid Infusions

• Replace administration sets no more frequently than at 96-hour intervals, but at least every 7 days for patients not receiving blood, blood products, or fat emulsions 1
• Evidence supports that changing IV administration sets every 72 hours or more does not increase risk of infusate-related or catheter-related bloodstream infection 6
• In low-risk patients not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying replacement up to 7 days may be safe and cost-effective 7

Special Infusates

• Replace tubing for blood, blood products, or fat emulsions within 24 hours of initiating infusion 1
• Replace propofol infusion tubing every 6 or 12 hours when the vial is changed per manufacturer recommendations 1

Needleless Connectors

• Change needleless components at least as frequently as the administration set, with no benefit to changing more frequently than every 72 hours 1
• Scrub access ports with appropriate antiseptic (chlorhexidine, povidone iodine, or 70% alcohol) before each access 1

Umbilical Catheters (Neonatal)

• Umbilical artery catheters should optimally not remain in place more than 5 days 5, 8
• Umbilical venous catheters can be used up to 14 days if managed aseptically 5, 8
• Remove immediately if signs of catheter-related bloodstream infection, vascular insufficiency, or thrombosis develop 8

Common Pitfalls to Avoid

• Do not routinely replace peripheral IVs at fixed intervals (72-96 hours) as this increases costs, patient discomfort, and catheter insertions without reducing complications 1, 2
• Do not discharge patients with non-cuffed central catheters due to risks of infection, inadvertent removal, and hemorrhage 5
• Do not use femoral catheters for more than 5 days in non-bed-bound patients 5
• Do not fail to monitor for signs of infection including exit site changes, fever, or systemic symptoms 5
• Catheter insertion by personnel other than specialized IV therapists increases infection risk 3