What are the IV (intravenous) cannula hygiene guidelines for nurses?

IV Cannula Hygiene Guidelines for Nurses

Nurses must perform hand hygiene before and after every contact with IV cannulae, use aseptic technique for all insertion and maintenance procedures, and replace peripheral IV cannulae every 72-96 hours while changing dressings immediately when they become damp, loosened, or soiled. 1

Hand Hygiene - The Single Most Critical Intervention

Hand hygiene is the most crucial step in preventing catheter-related infections and must be performed rigorously 2:

• Perform hand hygiene before and after palpating catheter insertion sites 1
• Perform hand hygiene before and after inserting, replacing, accessing, repairing, or dressing any intravascular catheter 1
• Use either conventional antiseptic-containing soap and water or waterless alcohol-based gels or foams 1
• Wearing gloves does not eliminate the need for hand hygiene 1
• Do not palpate the insertion site after antiseptic application unless aseptic technique is maintained 1

Skin Preparation and Antisepsis

For peripheral IV cannulae, prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, an iodophor, or chlorhexidine gluconate) before insertion 1:

• For central venous catheters, use 0.5% chlorhexidine preparation with alcohol as the preferred agent 1
• If chlorhexidine is contraindicated, use tincture of iodine, an iodophor, or 70% alcohol as alternatives 1
• Allow the antiseptic to dry completely according to manufacturer's recommendations before catheter insertion 1
• Allow povidone iodine to remain on skin for at least 2 minutes or until dry 1
• Never apply organic solvents (acetone or ether) to the skin 1

Dressing Management

Dressing Type Selection

Use either sterile gauze or sterile, transparent, semi-permeable dressing to cover the catheter site 1:

• If the patient is diaphoretic or if the site is bleeding or oozing, use gauze dressing until resolved 1
• Transparent dressings allow continuous visual inspection of the insertion site 3

Dressing Change Frequency

For peripheral IV cannulae with gauze dressings, replace when the catheter is removed or replaced, or when the dressing becomes damp, loosened, or soiled 1:

• For central venous catheters with gauze dressings, change every 2 days 1, 3
• For central venous catheters with transparent dressings, change at least every 7 days 1, 3
• Replace dressings more frequently in diaphoretic patients 1, 3
• Change dressings immediately if they become damp, loosened, or visibly soiled 1, 3

Critical Dressing Management Pitfalls

• Remove bulky dressings that prevent palpation or direct visualization daily for inspection and apply new dressing 1, 3
• Do not use topical antibiotic ointment or creams on insertion sites (except dialysis catheters) due to risk of promoting fungal infections and antimicrobial resistance 1
• Do not submerge the catheter or catheter site in water 1
• Showering is permitted if precautions protect the catheter from water exposure 1

Catheter Replacement and Removal

Replace peripheral venous catheters at least every 72-96 hours in adults to prevent phlebitis 1:

• In children, leave peripheral IV catheters in place until IV therapy is completed unless complications occur 1
• Promptly remove any intravascular catheter that is no longer essential 1
• When aseptic technique cannot be ensured during emergency insertion, replace the catheter within 48 hours 1
• Do not routinely replace central venous or arterial catheters solely to reduce infection 1

Aseptic Technique Requirements

Maintain aseptic technique for insertion and care of all intravascular catheters 1:

• Wear clean or sterile gloves when inserting catheters as required by OSHA Bloodborne Pathogens Standard 1
• Clean gloves are acceptable for peripheral IV insertion if the site is not touched after antiseptic application 1
• Sterile gloves must be worn for arterial and central catheter insertion 1

Administration Set Management

Replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, but at least every 7 days 1:

• Replace tubing used for blood, blood products, or fat emulsions within 24 hours of initiating infusion 1
• Replace tubing for propofol infusions every 6 or 12 hours per manufacturer recommendations 1
• Scrub access ports with appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) before accessing 1
• Change needleless connectors at least as frequently as administration sets, no more than every 72 hours 1

Education and Competency

Only trained personnel who demonstrate competence should insert and maintain peripheral and central intravascular catheters 1:

• Healthcare personnel must be educated on indications for catheter use, proper insertion and maintenance procedures, and infection control measures 1
• Periodically assess knowledge and adherence to guidelines for all personnel involved in catheter care 1
• Ensure appropriate nursing staff levels, as elevated patient-to-nurse ratios are associated with increased catheter-related bloodstream infections 1

Documentation Requirements

Record the operator, date, and time of catheter insertion and removal, and dressing changes on a standardized form 1:

• Do not routinely culture catheter tips 1
• Educate patients to report any changes in their catheter site or new discomfort 1