What is the recommended protocol for changing an intravenous (IV) line in a typical adult patient with a peripheral IV line in place?

IV Line Change Protocol

Peripheral IV Catheter Replacement

Replace peripheral IV catheters every 72-96 hours in adults to prevent phlebitis, or remove them based on clinical indication rather than a fixed schedule. 1

Standard Replacement Interval

• The CDC recommends replacing peripheral venous catheters at least every 72-96 hours in adults to prevent phlebitis. 1
• However, high-quality randomized controlled trial evidence demonstrates that clinically indicated replacement (removing catheters only when complications occur) is equivalent to routine 72-hour replacement in terms of phlebitis rates. 2
• When catheters are replaced based on clinical indication alone, closed-system PIVCs can safely remain in place for up to 144 hours, while open-system PIVCs can remain for up to 96 hours without increased infection risk. 3

Pediatric Considerations

• In children, leave peripheral venous catheters in place until IV therapy is completed, unless complications such as phlebitis or infiltration occur. 1

Emergency Placement Exception

• When aseptic technique cannot be ensured during catheter insertion (e.g., medical emergencies), replace all catheters as soon as possible and no later than 48 hours after insertion. 1

Administration Set Replacement

Standard Crystalloid Solutions

Replace administration sets, including secondary sets and add-on devices, no more frequently than every 72 hours unless catheter-related infection is suspected. 1

• Systematic reviews and randomized trials demonstrate that changing IV administration sets every 72-96 hours does not increase the risk of bloodstream infection compared to more frequent changes. 4, 5
• One study found that extending administration set changes to 4-7 days in low-risk patients (excluding those receiving TPN, blood products, or interleukin-2) was safe and cost-effective. 6

Special Infusate Requirements

Blood products and lipid-containing solutions require more frequent tubing changes:

• Replace tubing used to administer blood, blood products, or lipid emulsions (combined with amino acids and glucose in 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion. 1
• For solutions containing only dextrose and amino acids (no lipids), administration sets do not need replacement more frequently than every 72 hours. 1
• Replace tubing used to administer propofol infusions every 6 or 12 hours per manufacturer's recommendation. 1

Needleless Components

• Change needleless components at least as frequently as the administration set (every 72 hours). 1
• Change caps no more frequently than every 72 hours or according to manufacturer's recommendations. 1

Central Venous and Arterial Catheters

Do not routinely replace central venous or arterial catheters solely for infection prevention purposes. 1

• Central lines should remain in place until no longer clinically needed or until complications develop. 1

Dressing Changes

Transparent Dressings

• Change transparent dressings on central venous catheters every 7 days for short-term catheters. 7

Gauze Dressings

• Change gauze dressings every 2 days on central venous catheters. 7
• Use gauze dressings preferentially if the catheter site is bleeding, oozing, or if the patient is diaphoretic. 1, 7

Immediate Change Indications

• Change any dressing immediately when it becomes damp, loosened, or soiled. 7

Site Care and Maintenance

Antiseptic Protocols

• Clean injection ports with 70% alcohol or an iodophor before accessing the system. 1
• Wipe access ports with appropriate antiseptic and access only with sterile devices to minimize contamination risk. 1
• Cap all stopcocks when not in use. 1

Water Exposure

• Do not submerge catheters under water. 1
• Showering is permitted if the catheter and connecting device are protected with an impermeable cover. 1

Common Pitfalls

• Avoid routine scheduled replacement of central lines: This practice increases costs and patient discomfort without reducing infection rates. 1
• Do not change administration sets more frequently than necessary: Changing sets every 24-48 hours for standard crystalloid infusions provides no additional benefit and increases costs. 4, 5
• Remember lipid-containing solutions are different: These require 24-hour tubing changes regardless of the 72-96 hour rule for crystalloids. 1
• Emergency placements require early replacement: Catheters placed during emergencies without strict aseptic technique must be replaced within 48 hours. 1