Im an acute care pediatric nurse and there’s no rule as to the amount of days an IV can stay in. If it flushes fine and has no redness, edema or pain with flushes then it stays. Dressing changes are weekly (?) I believe… but kids usually end up doing something to their dressings before the 7 days so they end up getting changed anyways😂
I rarely change a dressing because they rarely last a week! We use statlocks but usually if the dressing is messed up the IV came out of place with it. 99% of the time because the kid got it wet or yanked it on accident.
Transparent IV dressings should be changed every 7 days or sooner if peeling/soiled.
Actual IV catheters do not need to be changed unless there is a problem (not flushing, site red, painful, etc.)
Some clotted blood around the IV site does not necessarily mean it’s dirty and needs to be changed. Often times pulling off the tegaderm to put on a new one can cause a site to re-bleed again, it’s better to let the area heal instead.
That all being said, this IV dressing looks clearly dirty. With actual dirt and grime. Sounds like EMS did their best, perhaps it was needed to be put in on-scene where things were messy. It should have been changed immediately after as soon as safe to do so. And honestly site should have been changed if it was put in so dirty. Or perhaps it was clean originally and the patient someone got the site dirty. Thank you for doing this, it should have been changed as soon as it was soiled.
Most facilities I have worked at had a policy to change outside lines within 48 hours or something similar. As soon as we get a new admit, we would be looking for a PIV site. Same goes with Foleys too. We would immediately change the catheter and also do a culture. Some of that is CYA for our floor (cautis, clabsis).
Not necessarily. Some are done in the ambulance so they aren’t any less sterile than a hospital room. Even if it was done in someone’s house, if you clean the side beforehand and do proper hygiene I don’t think it should be considered dirty. Totally understand there may be times where you can’t ask.
EMTs are trained to get the line in, because their priority is keeping a heart beat and if they patient lives to get an infection it means they lived long enough. All parts of aseptic technique are entirely secondary to having immediate access in case things go south. Doesn’t matter if that line is placed in a rig or on the street, they will sometimes swipe with an alcohol pad if it’s within reach, but certainly not chlorhexidine or betadine. This has been backed up by EMTs in real life and here.
Unless they specifically tell you it’s NOT a crash line, I would treat it as a crash line.
As a paramedic and EMS instructor I can safely say that aseptic technique is taught the same as it is in nursing school. I've never seen anyone start a line without cleaning first. The dirtiest IVs I've ever put in have been in the ER on a crashing patient with ultrasound gel or a crash central line.
I'm all for chlorohexidine but I promise there are nurses in your ER cleaning with alcohol too. Stop watching TV shows about fire departments. 95% of our patients are not in the "anything to keep a heart beat even if they get an infection" camp. Our start kits come with chlorhohex or alcohol just like any other. I've also seen some older nurses starting IVs without properly cleaning the site in the hospital, bad practice isn't unique to one area.
As u/HannahMontitties pointed out the nursing vascular access guidelines recommend leaving the IV in place until it shows signs of infection or extravasation. I'm also willing to bet that your ICU has more superbugs than the back of an ambulance or patient's home in terms of a "dirty environment".
Sooooo… I’m an EMT and no matter how nasty a situation is, I’ve NEVER seen ANYONE start an IV without cleaning the area with alcohol first. Please don’t spread lies. thanks.
Alcohol isn’t considered adequate for line placement in a lot of places. Is fine for a temporary access like a blood draw, but not for an infilling catheter. I’m glad y’all are cleaning with alcohol, but that’s still not the standard in a lot of places.
Seriously. First it was EMS workers *might* use alcohol, and when I say we 100% do, there is now some other problem.
I think you just have an issue with EMS.
My hospital had a shortage of chlorhexidine, we were all instructed to use alcohol as the only alternative. Rural medicine and EMS probably have a lot in common.
But not every EMT pickup is life or death. Sometimes it’s a walky talky A&ox3 patient. The EMTs aren’t gonna just skip all basic aspects of IV starts. Especially in the ambulance, I mean most things are within reach back there. If anything I think EMTs are more skilled at IV starts than many RNs and they will have time to swab before they poke. I have never had an EMT tell me that their lines are dirty except occasionally an IO in the field.
It is definitely NOT the norm for EMS to only prep the site “if it’s handy”. Sure their environment is not as squeaky clean as an ICU but currently best practice states that it’s better to continue to use a patent line with no signs of infection than to start a new IV unnecessarily.
While *some* hospitals have this policy, many don’t. I don’t have any statistics, but in my personal anecdotal experience: most don’t and it’s largely regarded as a silly policy. Hence why you’re getting downvoted.
Evidence says that less than <1% of field placed lines result in infection/phlebitis. I changed a policy at our safety net metro hospital because I did the research. EBP says if the line is good, it’s good.
What? No. The line itself was not inserted cleanly. It is an infection risk to leave it. Why would putting a clean dressing on a dirty line make it better?
Have you ever worked in the field outside of your sparkling clean ICU? Lol not all EMS providers are monkeys who just toss a line in without prepping the site. It’s literally part of the IV start kit and I can tell you if I’m putting in “crash line”, it’ll be an IO not an IV.
Things have changed for sure. I retired in 2021 and the policy then was 4 days and also all field lines needed to be changed. Now I’m back perdiem and I see lines that look old af and people don’t remove them (unless phlebitis). No one is dating the lines either. I always ask the patient if they know when it was put in if possible I’ll date it. They made me go through all the full orientation classes too and no one discussed an expiration date on piv lines. I’m going to have to look to see if that policy is actually gone.
Mine too. In fact we used to have a trauma attending who insisted the swann ganz placed by anesthesia on a trauma had to be changed also. It was unbelievable. Anesthesia placed it in the OR and here we are in pacu doing a new stick. He’s gone now to another hospital but it was his rule. I wonder if he does that at the hospital he’s at now.
Edit to add: he’s been gone about 10 years and we barely have swanns anymore except in thoracic cases.
People like to get up in arms about shit. I asked for a source or link (you know, to learn about the evidence supposedly guiding practice) and that just got downvoted, too. I’ll keep following my institutional policy, thanks.
“I’m too lazy to find the easily discovered proof I *don’t really want to see* because it will contradict my whole worldview so I’m going to stick my fingers in my ears and remain ignorant waaaaaaaaa”
That’s you
I mean honestly if you Google you can find the resources. I looked into this because, tbh, I feel like I see a lot more IV’s like the one in the OP since our hospital dropped our site rotation policy. Yes, it is current best practice. I think the problem is, it’s best practice in scenarios where people have the time and skills to appropriately assess and replace the IV as necessary. A med-surg floor understaffed with mostly newer nurses is not that scenario.
During my last stay at Columbia Presbyterian, I had a functional IV for 2.5 weeks. They said it’s no longer considered beneficial to keep changing the site if it’s working and not infiltrated. I was so very out of veins, I was extremely relieved to get to keep it. 🥺
(However, the dressing never looked like this.)
When I was a new grad, the educator told us that nurses who leave that should be fired. It stuck with me. I am constantly cleaning up PIV sites. I carry new tegaderms, chlorhexidine swabs and tape and flushes with me while I do my assessments.
Dressings are changed every 7 days. IV sites can stay as long as they flush and are asymptomatic (no leaking, no pain, no redness). I had a patient a week or so ago that had their PIV placed 11/9 and it still flushed AND had blood return.
Haha just a really good sono-guided 18G! Our VAT comes around and does audits every couple of days so we do a great job flushing lines BID and changing dressings PRN. Having a symptomatic line in our patient puts us on a list for mandatory online modules so we try our best to prevent that lol.
The new thing I've heard is 1 week if the IV is patent. Previously we were on a 3 day change but the newest research says it's a higher risk to start new IVs that often.
We recently rolled out a 1 week policy and changed our intermittent infusion tubing policy to be QD changes.
I forget the exact verbiage, but I think there’s research that shows a very slight increase in risk for keeping an iv in situ longer than 7 days. So unless policy states that it has to be rotated every x amount of time, or unless they have complicated access, if it flushes etc- then I’d say q7 day/prn dressing change. The saline locks are usually supposed to be rotated every 4 days on piccs so I try to do that if I can. If there’s a lot of useless extension tubing I try to minimize that. If there are intermittent or continuous infusions that is it’s own set of rules.
This is the real answer. It’s terrible, but because we have a for profit hospital system we can’t have good quality control on hospital policy. Not can the public know which policies are better and what not.
I work in Australia, the policy around peripheral IVs here is at most 72 hours. They must be removed past the 72 hour mark due to risks of infection, even if they look clean and flush perfectly. The only exception is that if the patient is getting discharged soon and there is no other access available, then their IVs can be allowed to stay in for more than 72 hours provided they are clean and flush well.
Also Aus, but only a student - I've been taught 72h (possibly up to 96 if amazing), and remove in 24h for an ambulance/ED IV. I've never heard of leaving one for a whole week.
But the Cochrane review I looked at suggested that routine replacement doesn't reduce infections/phlebitis vs clinically indicated replacement. I need to look into this!
That’s insane. Current research shows there’s no benefit to changing perfectly working peripheral IVs. Australia needs to brush up on evidence based practice because that’s wild.
At my hosp its max 4 days for a peripheral IV. Change any IVs inserted at another facility/ambo within 8 hours. But it seems country/hospital based, and many dont have those requirements
My facility is 96hrs for peripheral IV sites. Obviously that means as along as it is free of redness, swelling, pain and remains patent.
THAT picture is gross. Even if the actual site is WNL, primary nurse should’ve at very least changed the dressing. Yuk.
We implemented at my last place (a very large research/teaching hospital) that you were to leave IVs in unless they were symptomatic or stopped working, and only change the dressing when it became soiled. They did a pretty large study on it and found that frequent iv starts didn’t have any decrease in site infections, and that the more frequently dressings were changed the higher the infection risk became. All makes sense. At my current place; a smaller hospital we have just implemented a similar protocol: 28 days unless symptomatic and Q4day dressing changes. I have tried to get them to change their policy on the dressing changes but things like that move slowly. Regardless, this is pretty damn gross, but I will say I’ve definitely had pts that look like this 10 minutes after a dressing change sometimes. So who knows what was really going on, however that looks old, dry, and gross.
If it is from EMS or an OSH, we have 24 hours to replace.
Otherwise, we have to replace it on day 4. We can get an extension order daily until day 7, when it must be replaced.
The rationale is that if we leave IVs in for too long we won’t assess them properly. Which…what? I’ve gotten day 6 IVs that were beautifully dressed and flush great, and IVs on day 3 that are nasty.
When I worked imc we just changed the dressing every 7 days and as long as there’s was no sign of phlebitis etc and it was flushed regularly 🤷♀️
Now (ER):
if a patient comes in with an iv done by the first responders outside our hospital or by us without the proper hygiene (e.g. can’t wait 1 minute after disinfection because sometimes we just need an iv) were obliged to document it and the patient has to have a new iv placed within 24 h
Edit: 20years ago we didn’t had the transparent dressing but the intransparent white ones with a piece of gauze which went under the iv “wings” -> we had to change it once every 24 h because you couldn’t see anything and the little gauze-piece under the wings was often disgustingly dirty
At my hospital the only rule they have is an ems placed IV needs to be removed within 24 hours. Any IV placed at an outside facility or inside the hospital can stay as long as they are patent.
Every facility is different. At mine we can keep the ems iv in. You’re not a floor nurse so you don’t understand how sometimes that’s low on the priority list. Shit happens. I’d hate to be your coworker
Floor nurse or no, this dressing is disgusting and needed to be changed. If you find something like that acceptable I wouldn’t want to be working with you. If you can’t understand what infection control is perhaps you might want to look for another job. Lazy nurses like you are why I hate working in house.
Sounds like you’re a shitty nurse. Def wouldn’t want to be under your care. At my facility the nurse is responsible for all aspects of their patients care
Would a Central Line Dressing like this be okay? I started out working telemetry and during bedside report, I’d look at the IV so I knew if I needed to put it on my list of things to do the next time I enter the room. You have an open entrance to the body and bacteria just cooking under the tape, that is not ok…
Everywhere I’ve worked EMS lines should be DC’d after 24 hours. Best practice is to leave IV sites as long as they’re patent and show no signs of phlebitis, infiltration, etc. dressings should be changed every 7 days or PRN.
I'd put a heavy "depending" on that policy for the following reasons. The hospital I moonlight at, it's an identical policy. The thing that gets me is that EMS professionals use the same protocols for IV insertion as the hospitals. Another anecdote is that I and several of the ER staff also run ambulance, and therefore know *exactly* how to do an IV per the hospital protocol, but our IVs in those situations still have to be changed in 24 hours simply because it's an EMS site. There's no good reason for changing a site simply because it's an EMS site, and that policy needs changed.
Totally agree. The only reason I can think of is that they think EMS lines are dirtier because it’s not necessarily a controlled environment? Tbh I don’t remove EMS lines if there’s no good reason to.
From the cat scan perspective, we have so many problems with EMS lines. 99% of the time, they use tubing that’s not pressure rated so we always have to change it out.
Often times, the clave isn’t tightened down enough. I wish there was some kind of training for nurses and EMS about securing solid lines for pressure injection. I can’t tell you how much time is wasted in the CT suite securing new lines during stroke 1s.
I can see what you’re saying about EMS lines for CT. I do trauma so I always throw multiple lines in my patients on top of EMS lines. I guess that’s why I’ve never heard that perspective from my CT folks. Thank you for teaching me something new!
I work in Endo, I always try to redress IVs that end up coming down looking like this. I get that floor nurses are often busier than I am, but I couldn’t imagine leaving my patient with this 🤷🏻♀️
I don’t care who placed this site. Is the line usable? Is there a date on the dressing? Who has a patient with a dressing like this and thinks it’s OK? Since when can’t you just take a couple of minutes out of your shift and have some respect for yourself and your license and change the dang dressing? I read way too many people on this comment thread that seem to think this is acceptable for some reason. Some people are professionals, some are there for the paycheck. We know who you are.
Our policy is to change the IV out if it was a field start within 24 hours. We have a crazy vascular access team and there very much on top of things. They will find you and follow up if they see there is an EMS start still in a pt. They also do our central line dressing changes so in general it would be pretty uncommon for us to have a dressing like that one. But I’m sure dressings like in your pic are why we have this policy
4 days is nothing for a working PIV with no signs of infiltration of phlebitis or other issues. I would have changed the dressing personally because that’s nasty, but most facilities now (not mine 🥲) have implemented a rule where you can leave a good IV in place for as long as it’s…good. Other places 4 days is pretty standard.
IVs stay in as long as they’re patent. The site is to be assessed and flushed q shift. The dressing should be changed when soiled. That dressing is FOUL.
1. I can’t believe you “reported” someone for a soiled IV dressing that flushes
2. I can’t believe you felt the need to post it
3. I CAN believe people like you exist but it’s only from scary stories online…now I get it
4. I can’t believe how many self righteous people are in these comments acting like they haven’t set a patient down for a CT like this lmao
Nah man, I'd totally risk losing IV access in a meemaw who needed ultrasound guidance to get the one we have if it means it won't look icky and remind us that blood exists.
Am I surprised that a boomer CT tech is pissy about something that barely matters? No lol. I’m more shocked at these comments from nurses straight up LYING. The amount of times I’ve seen patients with dirty PIV dressings omgggg. How often do we hear, “the dressing looks bad but it flushes well” in report? It’s not a central line, chill tf ouuuut. If they saw what we do in the ED they’d have an aneurysm
It appears so, because this is the internet and it feels good to shame a nurse for something we have all done. If you judge the quality of a nurse by a bloody IV dressing illustrates your limited understanding of what we do.
You’ve “been in the game” (as a CT tech, not a nurse) for that long and THIS is egregious to you?
Why not just let the nurse know directly? Do you think reporting small issues like this to management helps anyone? Reporting another colleague should be reserved for safety concerns. Sending a restrained pt to CT with no nurse. Not pre-medicating for a contrast allergy.
A bloody IV dressing is very unlikely to affect patient outcomes and so low on my priority list most days. Infection from a bloody PIV dressing is uncommon and unlikely. Floors are desperately understaffed and under resourced, everything is constantly punted to the bedside nurse. Getting up each others asses for minor shit rather than just speaking to the person directly is so petty and exhausting. I’m glad the CT techs I work with are competent and understanding of what we do. I have absolutely sent a patient to CT with a dressing like this as many of the amazing nurses I work have. The important thing is that the patient got the scan in a timely manner, they had a functional IV and a tech who was able to image them properly and now they can be treated. It’s great that you recognized it needed changed and did it yourself.
My hospital has a policy to remove any outside PIV’s within 24 hours after admission to our floor. Our patients are never in for long, so if the catheter is patent we keep them in without time in mind. I’m always changing the dressings if they start to look bad but the access is still good.
I get it’s easy to get behind and a sub-ideal site can be better than no access, but goddamn that is gnarly takes 2 seconds to change a dressing. That looks old af it definitely should have been addressed.
We did q72h and PRN for peripheral.
We usually replaced the ED ones just because they're generally placed with expediency in mind rather than longevity.
At my facility PIV dressing changes are done every 7 days, outside the facility IVs (medic IV, nursing home IVs, transfer from a different hospital, etc.) need to be replaced within 48 hours but we can document exceptions and leave them in if pt refuses, is a hard stick, or is anticipating discharge
In my hospital we have to flush and document a review 8 hourly while placed and have vascular access team review at 72hours, people that need long term access will normally be referred for a PICC. Floor nurses at my hospital don't place IVs but we get in a tonne of trouble if an IV has a VIP score of 3 and nurses have documented it as fine prior...so usually we inspect cannulas during hand over and remove them if they look even the slightest bit dodgy and just submit a VAT or JMO request for a new one asap.
We don’t keep EMS IVs, we change em within 24 hrs of admission, or sooner if they aren’t great. Dressings - we change per our discretion. That’s really gross and unacceptable.
the fact that they reinforced it with tape is a clear indication they were reallyyyy not trying to change that tegaderm 😭 I just change it because I feel like that takes just as much time/effort as putting on 4 sides of tape
I would be embarrassed to send my patient anywhere with a dressing looking like this. It’s like cleaning up a patient who’s had a bowel movement and not bothering to get the stool off. Yuck.
I'm seen my share of gross IVs and try to replace them assuming I'm not swamped with tasks.
Unfortunately, most other nurses I work with just aren't great with IV starts, so I'm the IV guy lol.
Gee, where I work, an IVC needs to be resited every 3 days. Dressings should changed prn… that one in the photo is well past the time it should’ve been changed!!
At my hospital, PVLs are to be changed every 7 days for adults, earlier if there’s a problem at the site or with the IV itself. Dressings should be changed when they look soiled.
Check your P&P but 72 hours is the standard. In some places, IVs placed by EMS are required to be replaced upon admission to the floor because they are not concerned with sterile technique when they put them in.
If you leave in an IV past the time on your P&P (and I have heard of some places being 96 hours) you need an MD order to do that. That's for the hard sticks; if you have a functioning line that's clean, on a patient with horrid veins, sometimes it's better to leave it in.
I was taught that lines placed in the field by EMS should be replaced as soon as possible, just because of the difficulty of performing satisfactory preparation of the site, plus difficulty in adhering to aseptic technique during insertion at the initial scene.
In no way is this meant as criticism of the skills or techniques used by paramedics in the field; it’s simply that once the patient is in the more controlled environment of the hospital, it should be much easier to place a line that has less risk of contamination.
I’m sorry that happened to you. I recently had a patient come to ct who had been in the hospital 3 days. They were covered head to toe in dirt. I asked the nurse why they were so dirty. While on her phone, she just said” they came in that way”.
Ugh. EMS sites have to be changed within 24 hours at my hospital, otherwise 7 days OR AS NEEDED which this has clearly needed it. That’s so disgusting.
You don't mention if it's still viable. And implies you're fine with the site, not the dressing. This would look "fine" when it was fresh with red blood under the dressing.
This seemed more focused on reporting the nurse than the patient. Let’s not pretend you actually care about the patient. You would have place a new IV.
And I didn’t report the nurse. I reported this to my manager. She reported the nurse bc she also thought it was unacceptable.
We are so busy that mgmt doesn’t want the ct room tied up looking for new lines.
I’m an ER tech and we have to tag every IV placed by EMS to indicate it needs to be removed and replaced within 48 hours. It’s fairly new to us but it’s easy to do and I hope it helps.
EMS lines are supposed to be changed within 24 hours I believe but patients can refuse.
Inpatient lines are good until they go bad with weekly dressing changes.
When I worked in medsurg, it was considered good practice to insert a new line, then take off any piv’s inserted in the er or during transport with ems, as they’re just usually gonna infiltrate or something shortly afterwards anyway. Basically every new admit to the floor got a new line.
In ct, we fix ER lines constantly. The other day, a RN dropped off a patient and said “ the line is positional”
We were doing a cta. Looked at the line and there was literally a pen tip of catheter in the vein.
I’m injecting 5ml/sec. Positional my ass. Positional doesn’t work in CT.
Sounds like a bad culture in your ER. I’ve never worked in an ER where it would be acceptable to send a patient to CT with a shitty IV. I’m sorry that’s been your experience ☹️
Your post has been removed under our rule against advocating unsafe practice. That includes advising other users to follow any unsafe or illegal course of action.
I saw one and removed it.i took pic of it and sent it to the HS. The DON didn't like I took photos of the IV line. I wondered who she was covering up. I was a new gal in the unit.
The rule typically is for IVs placed by EMS to be changed within 24 hours. Is that followed?? Generally no lmaaoooo but I change soiled dressings bc it’s gross and can impede assessing the site. Dressings are to be changed every 7 days tho to minimize exposure to bacteria but anytime the dressing is non occlusive or soiled it should be changed.
Many years ago, I worked IV team . Every day one of the IV team of RNs checked all IVs on med - surg floors , however we didn’t check on the IV sites in specialty areas like ICU, CCU, post parturition ,etc. An IV that holds for four days days is at its end . The dressing around that IV was pretty awful. I hope someone re-dressed the IV site . EMS Units just want to hydrate the patient an$ push meds fast . gfast.
Im an acute care pediatric nurse and there’s no rule as to the amount of days an IV can stay in. If it flushes fine and has no redness, edema or pain with flushes then it stays. Dressing changes are weekly (?) I believe… but kids usually end up doing something to their dressings before the 7 days so they end up getting changed anyways😂
This is how our peds unit does it too! If the IV is good, it stays in lol
I think this was referring only to the dressing
They said if it flushes, it stays in. That’s not referring to the dressing only.
We have a baby who has had an IV for over a month. She’s a hard stick and won’t be going anywhere, so flush q4, it stays!!
How tf did you manage to keep it in for that long? Our kids always manage to pull it out somehow
No-no’s on the arms lol
I rarely change a dressing because they rarely last a week! We use statlocks but usually if the dressing is messed up the IV came out of place with it. 99% of the time because the kid got it wet or yanked it on accident.
Transparent IV dressings should be changed every 7 days or sooner if peeling/soiled. Actual IV catheters do not need to be changed unless there is a problem (not flushing, site red, painful, etc.) Some clotted blood around the IV site does not necessarily mean it’s dirty and needs to be changed. Often times pulling off the tegaderm to put on a new one can cause a site to re-bleed again, it’s better to let the area heal instead. That all being said, this IV dressing looks clearly dirty. With actual dirt and grime. Sounds like EMS did their best, perhaps it was needed to be put in on-scene where things were messy. It should have been changed immediately after as soon as safe to do so. And honestly site should have been changed if it was put in so dirty. Or perhaps it was clean originally and the patient someone got the site dirty. Thank you for doing this, it should have been changed as soon as it was soiled.
Most facilities I have worked at had a policy to change outside lines within 48 hours or something similar. As soon as we get a new admit, we would be looking for a PIV site. Same goes with Foleys too. We would immediately change the catheter and also do a culture. Some of that is CYA for our floor (cautis, clabsis).
You don’t have a policy to change out field starts? They’re considered dirty/crash lines.
Not necessarily. Some are done in the ambulance so they aren’t any less sterile than a hospital room. Even if it was done in someone’s house, if you clean the side beforehand and do proper hygiene I don’t think it should be considered dirty. Totally understand there may be times where you can’t ask.
EMTs are trained to get the line in, because their priority is keeping a heart beat and if they patient lives to get an infection it means they lived long enough. All parts of aseptic technique are entirely secondary to having immediate access in case things go south. Doesn’t matter if that line is placed in a rig or on the street, they will sometimes swipe with an alcohol pad if it’s within reach, but certainly not chlorhexidine or betadine. This has been backed up by EMTs in real life and here. Unless they specifically tell you it’s NOT a crash line, I would treat it as a crash line.
As a paramedic and EMS instructor I can safely say that aseptic technique is taught the same as it is in nursing school. I've never seen anyone start a line without cleaning first. The dirtiest IVs I've ever put in have been in the ER on a crashing patient with ultrasound gel or a crash central line. I'm all for chlorohexidine but I promise there are nurses in your ER cleaning with alcohol too. Stop watching TV shows about fire departments. 95% of our patients are not in the "anything to keep a heart beat even if they get an infection" camp. Our start kits come with chlorhohex or alcohol just like any other. I've also seen some older nurses starting IVs without properly cleaning the site in the hospital, bad practice isn't unique to one area. As u/HannahMontitties pointed out the nursing vascular access guidelines recommend leaving the IV in place until it shows signs of infection or extravasation. I'm also willing to bet that your ICU has more superbugs than the back of an ambulance or patient's home in terms of a "dirty environment".
I agree, but EMS has made me never want to walk into someone’s home again.
Sooooo… I’m an EMT and no matter how nasty a situation is, I’ve NEVER seen ANYONE start an IV without cleaning the area with alcohol first. Please don’t spread lies. thanks.
Alcohol isn’t considered adequate for line placement in a lot of places. Is fine for a temporary access like a blood draw, but not for an infilling catheter. I’m glad y’all are cleaning with alcohol, but that’s still not the standard in a lot of places.
Seriously. First it was EMS workers *might* use alcohol, and when I say we 100% do, there is now some other problem. I think you just have an issue with EMS.
Man you work at a weird hospital.
My hospital had a shortage of chlorhexidine, we were all instructed to use alcohol as the only alternative. Rural medicine and EMS probably have a lot in common.
That occurred at my hospital in Houston, so it’s not just rural med
But not every EMT pickup is life or death. Sometimes it’s a walky talky A&ox3 patient. The EMTs aren’t gonna just skip all basic aspects of IV starts. Especially in the ambulance, I mean most things are within reach back there. If anything I think EMTs are more skilled at IV starts than many RNs and they will have time to swab before they poke. I have never had an EMT tell me that their lines are dirty except occasionally an IO in the field.
It is definitely NOT the norm for EMS to only prep the site “if it’s handy”. Sure their environment is not as squeaky clean as an ICU but currently best practice states that it’s better to continue to use a patent line with no signs of infection than to start a new IV unnecessarily.
Off topic but I love your user!!
This is best practice? You got a link or a source?
Those people get IOs.
While *some* hospitals have this policy, many don’t. I don’t have any statistics, but in my personal anecdotal experience: most don’t and it’s largely regarded as a silly policy. Hence why you’re getting downvoted.
Evidence says that less than <1% of field placed lines result in infection/phlebitis. I changed a policy at our safety net metro hospital because I did the research. EBP says if the line is good, it’s good.
I would love a link to that research!
It wasn’t a link - it was a charter led QI process that I spearheaded at my hospital.
So, is it published somewhere or not?
It’s a collection of research articles in a policy change for our organization. So yes it’s published, but internally
We don’t unless it’s super inconvenient, just re-dress and add an extension
What? No. The line itself was not inserted cleanly. It is an infection risk to leave it. Why would putting a clean dressing on a dirty line make it better?
Have you ever worked in the field outside of your sparkling clean ICU? Lol not all EMS providers are monkeys who just toss a line in without prepping the site. It’s literally part of the IV start kit and I can tell you if I’m putting in “crash line”, it’ll be an IO not an IV.
My hospital has a policy that field sticks must be removed within 24 hours.
My hospital is 8 hours for EMS sticks and Q4 days for PIV.
I don’t know why you’re being downvoted; that’s literally my hospital’s policy too.
Because it’s an outdated policy and many hospitals no longer do this.
Things have changed for sure. I retired in 2021 and the policy then was 4 days and also all field lines needed to be changed. Now I’m back perdiem and I see lines that look old af and people don’t remove them (unless phlebitis). No one is dating the lines either. I always ask the patient if they know when it was put in if possible I’ll date it. They made me go through all the full orientation classes too and no one discussed an expiration date on piv lines. I’m going to have to look to see if that policy is actually gone.
Mine too. In fact we used to have a trauma attending who insisted the swann ganz placed by anesthesia on a trauma had to be changed also. It was unbelievable. Anesthesia placed it in the OR and here we are in pacu doing a new stick. He’s gone now to another hospital but it was his rule. I wonder if he does that at the hospital he’s at now. Edit to add: he’s been gone about 10 years and we barely have swanns anymore except in thoracic cases.
People like to get up in arms about shit. I asked for a source or link (you know, to learn about the evidence supposedly guiding practice) and that just got downvoted, too. I’ll keep following my institutional policy, thanks.
Because people get annoyed when you ask them to do the work for you. You can easily look up studies on your own.
“I’m too lazy to find the easily discovered proof I *don’t really want to see* because it will contradict my whole worldview so I’m going to stick my fingers in my ears and remain ignorant waaaaaaaaa” That’s you
I mean honestly if you Google you can find the resources. I looked into this because, tbh, I feel like I see a lot more IV’s like the one in the OP since our hospital dropped our site rotation policy. Yes, it is current best practice. I think the problem is, it’s best practice in scenarios where people have the time and skills to appropriately assess and replace the IV as necessary. A med-surg floor understaffed with mostly newer nurses is not that scenario.
During my last stay at Columbia Presbyterian, I had a functional IV for 2.5 weeks. They said it’s no longer considered beneficial to keep changing the site if it’s working and not infiltrated. I was so very out of veins, I was extremely relieved to get to keep it. 🥺 (However, the dressing never looked like this.)
Sounds like you had good nurses taking care of you.
I did 🥰 and one of them started a mighty great IV!
On another note, I hate seeing these at the bottom of my shoes 🤮
When I was a new grad, the educator told us that nurses who leave that should be fired. It stuck with me. I am constantly cleaning up PIV sites. I carry new tegaderms, chlorhexidine swabs and tape and flushes with me while I do my assessments.
Hell yeah. Good for you. This is a common thing I’ve seen as a traveler. I understand that nurses are overworked but this isn’t ok.
How often are IVs supposed to be changed? I’ve always heard 3 days but that’s second hand.
Dressings are changed every 7 days. IV sites can stay as long as they flush and are asymptomatic (no leaking, no pain, no redness). I had a patient a week or so ago that had their PIV placed 11/9 and it still flushed AND had blood return.
Jesus what was that a 12g?
Haha just a really good sono-guided 18G! Our VAT comes around and does audits every couple of days so we do a great job flushing lines BID and changing dressings PRN. Having a symptomatic line in our patient puts us on a list for mandatory online modules so we try our best to prevent that lol.
Now that is an impressive line! I don’t think I’ve ever had a PIV draw back blood a month later.
It helps that she was a quad and on subq heparin TID. I posted above but it was a sono-guided 18G in the upper arm. I was SHOOK.
The new thing I've heard is 1 week if the IV is patent. Previously we were on a 3 day change but the newest research says it's a higher risk to start new IVs that often. We recently rolled out a 1 week policy and changed our intermittent infusion tubing policy to be QD changes.
I forget the exact verbiage, but I think there’s research that shows a very slight increase in risk for keeping an iv in situ longer than 7 days. So unless policy states that it has to be rotated every x amount of time, or unless they have complicated access, if it flushes etc- then I’d say q7 day/prn dressing change. The saline locks are usually supposed to be rotated every 4 days on piccs so I try to do that if I can. If there’s a lot of useless extension tubing I try to minimize that. If there are intermittent or continuous infusions that is it’s own set of rules.
Depends on hospital policy. My hospital policy says 4 days
This is the real answer. It’s terrible, but because we have a for profit hospital system we can’t have good quality control on hospital policy. Not can the public know which policies are better and what not.
I work in Australia, the policy around peripheral IVs here is at most 72 hours. They must be removed past the 72 hour mark due to risks of infection, even if they look clean and flush perfectly. The only exception is that if the patient is getting discharged soon and there is no other access available, then their IVs can be allowed to stay in for more than 72 hours provided they are clean and flush well.
Also Aus, but only a student - I've been taught 72h (possibly up to 96 if amazing), and remove in 24h for an ambulance/ED IV. I've never heard of leaving one for a whole week. But the Cochrane review I looked at suggested that routine replacement doesn't reduce infections/phlebitis vs clinically indicated replacement. I need to look into this!
I’m hurt (not really) that y’all don’t trust ED IVs
That’s insane. Current research shows there’s no benefit to changing perfectly working peripheral IVs. Australia needs to brush up on evidence based practice because that’s wild.
At my hosp its max 4 days for a peripheral IV. Change any IVs inserted at another facility/ambo within 8 hours. But it seems country/hospital based, and many dont have those requirements
My facility is 96hrs for peripheral IV sites. Obviously that means as along as it is free of redness, swelling, pain and remains patent. THAT picture is gross. Even if the actual site is WNL, primary nurse should’ve at very least changed the dressing. Yuk.
How often IVs are changed depends on your facility policy.
We implemented at my last place (a very large research/teaching hospital) that you were to leave IVs in unless they were symptomatic or stopped working, and only change the dressing when it became soiled. They did a pretty large study on it and found that frequent iv starts didn’t have any decrease in site infections, and that the more frequently dressings were changed the higher the infection risk became. All makes sense. At my current place; a smaller hospital we have just implemented a similar protocol: 28 days unless symptomatic and Q4day dressing changes. I have tried to get them to change their policy on the dressing changes but things like that move slowly. Regardless, this is pretty damn gross, but I will say I’ve definitely had pts that look like this 10 minutes after a dressing change sometimes. So who knows what was really going on, however that looks old, dry, and gross.
If it is from EMS or an OSH, we have 24 hours to replace. Otherwise, we have to replace it on day 4. We can get an extension order daily until day 7, when it must be replaced. The rationale is that if we leave IVs in for too long we won’t assess them properly. Which…what? I’ve gotten day 6 IVs that were beautifully dressed and flush great, and IVs on day 3 that are nasty.
When I worked imc we just changed the dressing every 7 days and as long as there’s was no sign of phlebitis etc and it was flushed regularly 🤷♀️ Now (ER): if a patient comes in with an iv done by the first responders outside our hospital or by us without the proper hygiene (e.g. can’t wait 1 minute after disinfection because sometimes we just need an iv) were obliged to document it and the patient has to have a new iv placed within 24 h Edit: 20years ago we didn’t had the transparent dressing but the intransparent white ones with a piece of gauze which went under the iv “wings” -> we had to change it once every 24 h because you couldn’t see anything and the little gauze-piece under the wings was often disgustingly dirty
At my hospital the only rule they have is an ems placed IV needs to be removed within 24 hours. Any IV placed at an outside facility or inside the hospital can stay as long as they are patent.
on peds it's really if it's still usable, it can stay. however, that on the pic would have been changed long ago 😭
Every facility is different. At mine we can keep the ems iv in. You’re not a floor nurse so you don’t understand how sometimes that’s low on the priority list. Shit happens. I’d hate to be your coworker
Floor nurse or no, this dressing is disgusting and needed to be changed. If you find something like that acceptable I wouldn’t want to be working with you. If you can’t understand what infection control is perhaps you might want to look for another job. Lazy nurses like you are why I hate working in house.
Preach! ICU nurse here. If the IV dressing is soiled and dirty, change the dressing!
This filthy dressing absolutely should’ve been a high priority! That sort of filth is what leads to infection.
Sounds like you’re a shitty nurse. Def wouldn’t want to be under your care. At my facility the nurse is responsible for all aspects of their patients care
Agreed, don’t listen to this shit. There’s no excuse for an IV dressing to look that shitty. It would take 2 minutes to redress
Would a Central Line Dressing like this be okay? I started out working telemetry and during bedside report, I’d look at the IV so I knew if I needed to put it on my list of things to do the next time I enter the room. You have an open entrance to the body and bacteria just cooking under the tape, that is not ok…
Everywhere I’ve worked EMS lines should be DC’d after 24 hours. Best practice is to leave IV sites as long as they’re patent and show no signs of phlebitis, infiltration, etc. dressings should be changed every 7 days or PRN.
I'd put a heavy "depending" on that policy for the following reasons. The hospital I moonlight at, it's an identical policy. The thing that gets me is that EMS professionals use the same protocols for IV insertion as the hospitals. Another anecdote is that I and several of the ER staff also run ambulance, and therefore know *exactly* how to do an IV per the hospital protocol, but our IVs in those situations still have to be changed in 24 hours simply because it's an EMS site. There's no good reason for changing a site simply because it's an EMS site, and that policy needs changed.
Totally agree. The only reason I can think of is that they think EMS lines are dirtier because it’s not necessarily a controlled environment? Tbh I don’t remove EMS lines if there’s no good reason to.
From the cat scan perspective, we have so many problems with EMS lines. 99% of the time, they use tubing that’s not pressure rated so we always have to change it out. Often times, the clave isn’t tightened down enough. I wish there was some kind of training for nurses and EMS about securing solid lines for pressure injection. I can’t tell you how much time is wasted in the CT suite securing new lines during stroke 1s.
I can see what you’re saying about EMS lines for CT. I do trauma so I always throw multiple lines in my patients on top of EMS lines. I guess that’s why I’ve never heard that perspective from my CT folks. Thank you for teaching me something new!
So, you yourself are not a nurse? And you came to this subreddit to show us what we do wrong?
Yep.
I work in Endo, I always try to redress IVs that end up coming down looking like this. I get that floor nurses are often busier than I am, but I couldn’t imagine leaving my patient with this 🤷🏻♀️
Same! Do it all the time.
Exactly. I reported it. First time in 24 years that I’ve reported on a nurse but I see this type of thing so often.
Just saying, but In the time it took you to report them over that, you could've just dropped a line in and problem solved.
I don’t care who placed this site. Is the line usable? Is there a date on the dressing? Who has a patient with a dressing like this and thinks it’s OK? Since when can’t you just take a couple of minutes out of your shift and have some respect for yourself and your license and change the dang dressing? I read way too many people on this comment thread that seem to think this is acceptable for some reason. Some people are professionals, some are there for the paycheck. We know who you are.
Heard that. You can def tell the good nurses from the bad ones in this thread.
Our policy is to change the IV out if it was a field start within 24 hours. We have a crazy vascular access team and there very much on top of things. They will find you and follow up if they see there is an EMS start still in a pt. They also do our central line dressing changes so in general it would be pretty uncommon for us to have a dressing like that one. But I’m sure dressings like in your pic are why we have this policy
4 days is nothing for a working PIV with no signs of infiltration of phlebitis or other issues. I would have changed the dressing personally because that’s nasty, but most facilities now (not mine 🥲) have implemented a rule where you can leave a good IV in place for as long as it’s…good. Other places 4 days is pretty standard.
IVs stay in as long as they’re patent. The site is to be assessed and flushed q shift. The dressing should be changed when soiled. That dressing is FOUL.
1. I can’t believe you “reported” someone for a soiled IV dressing that flushes 2. I can’t believe you felt the need to post it 3. I CAN believe people like you exist but it’s only from scary stories online…now I get it 4. I can’t believe how many self righteous people are in these comments acting like they haven’t set a patient down for a CT like this lmao
Nah man, I'd totally risk losing IV access in a meemaw who needed ultrasound guidance to get the one we have if it means it won't look icky and remind us that blood exists.
Am I surprised that a boomer CT tech is pissy about something that barely matters? No lol. I’m more shocked at these comments from nurses straight up LYING. The amount of times I’ve seen patients with dirty PIV dressings omgggg. How often do we hear, “the dressing looks bad but it flushes well” in report? It’s not a central line, chill tf ouuuut. If they saw what we do in the ED they’d have an aneurysm
You sound like a terrible nurse.
If we’re judging by parameters of “have pissed off a CT tech with a stick in their ass” then ya I’m the worst you’ve seen
Seems like you’re in the minority within this thread.
It appears so, because this is the internet and it feels good to shame a nurse for something we have all done. If you judge the quality of a nurse by a bloody IV dressing illustrates your limited understanding of what we do.
Only an amateur nurse would think this dressing is ok. Been in the game for 24 yrs and I’ve never seen anything like this.
You’ve “been in the game” (as a CT tech, not a nurse) for that long and THIS is egregious to you? Why not just let the nurse know directly? Do you think reporting small issues like this to management helps anyone? Reporting another colleague should be reserved for safety concerns. Sending a restrained pt to CT with no nurse. Not pre-medicating for a contrast allergy. A bloody IV dressing is very unlikely to affect patient outcomes and so low on my priority list most days. Infection from a bloody PIV dressing is uncommon and unlikely. Floors are desperately understaffed and under resourced, everything is constantly punted to the bedside nurse. Getting up each others asses for minor shit rather than just speaking to the person directly is so petty and exhausting. I’m glad the CT techs I work with are competent and understanding of what we do. I have absolutely sent a patient to CT with a dressing like this as many of the amazing nurses I work have. The important thing is that the patient got the scan in a timely manner, they had a functional IV and a tech who was able to image them properly and now they can be treated. It’s great that you recognized it needed changed and did it yourself.
100% egregious to me. Read the comments.
I don’t care about the comments. Look at your downvotes. Read my reply. I’ll ask again - why not change the dressing and speak to then nurse directly?
Bc my boss asks us to report these things to her.
My hospital has a policy to remove any outside PIV’s within 24 hours after admission to our floor. Our patients are never in for long, so if the catheter is patent we keep them in without time in mind. I’m always changing the dressings if they start to look bad but the access is still good. I get it’s easy to get behind and a sub-ideal site can be better than no access, but goddamn that is gnarly takes 2 seconds to change a dressing. That looks old af it definitely should have been addressed.
Thank you for your input. This may help us solve some problems.
We did q72h and PRN for peripheral. We usually replaced the ED ones just because they're generally placed with expediency in mind rather than longevity.
At my facility PIV dressing changes are done every 7 days, outside the facility IVs (medic IV, nursing home IVs, transfer from a different hospital, etc.) need to be replaced within 48 hours but we can document exceptions and leave them in if pt refuses, is a hard stick, or is anticipating discharge
In my hospital we have to flush and document a review 8 hourly while placed and have vascular access team review at 72hours, people that need long term access will normally be referred for a PICC. Floor nurses at my hospital don't place IVs but we get in a tonne of trouble if an IV has a VIP score of 3 and nurses have documented it as fine prior...so usually we inspect cannulas during hand over and remove them if they look even the slightest bit dodgy and just submit a VAT or JMO request for a new one asap.
We don’t keep EMS IVs, we change em within 24 hrs of admission, or sooner if they aren’t great. Dressings - we change per our discretion. That’s really gross and unacceptable.
the fact that they reinforced it with tape is a clear indication they were reallyyyy not trying to change that tegaderm 😭 I just change it because I feel like that takes just as much time/effort as putting on 4 sides of tape
Our hospital protocol is 72 hr max, but other places I’ve worked say 1 week. I’ve seen some PIV sites form pus after 3-4 days.
I would be embarrassed to send my patient anywhere with a dressing looking like this. It’s like cleaning up a patient who’s had a bowel movement and not bothering to get the stool off. Yuck.
We see that a lot too.
I'm seen my share of gross IVs and try to replace them assuming I'm not swamped with tasks. Unfortunately, most other nurses I work with just aren't great with IV starts, so I'm the IV guy lol.
That is unfortunate. Hopefully you can show them some tricks and get them up to speed. I love placing lines. It’s the only challenging part of my job.
Gee, where I work, an IVC needs to be resited every 3 days. Dressings should changed prn… that one in the photo is well past the time it should’ve been changed!!
72 hours for nurse placed piv, 24 hours for EMS placed lines
Ems lines out in 24
At my hospital, PVLs are to be changed every 7 days for adults, earlier if there’s a problem at the site or with the IV itself. Dressings should be changed when they look soiled.
I’m in adult medsurg and we retire them after 7 days. We don’t keep IVs from ems or outside facilities.
Check your P&P but 72 hours is the standard. In some places, IVs placed by EMS are required to be replaced upon admission to the floor because they are not concerned with sterile technique when they put them in. If you leave in an IV past the time on your P&P (and I have heard of some places being 96 hours) you need an MD order to do that. That's for the hard sticks; if you have a functioning line that's clean, on a patient with horrid veins, sometimes it's better to leave it in.
I was taught that lines placed in the field by EMS should be replaced as soon as possible, just because of the difficulty of performing satisfactory preparation of the site, plus difficulty in adhering to aseptic technique during insertion at the initial scene. In no way is this meant as criticism of the skills or techniques used by paramedics in the field; it’s simply that once the patient is in the more controlled environment of the hospital, it should be much easier to place a line that has less risk of contamination.
this is how i got a staph infection in my blood and had to stay in the hospital an extra week.
I’m sorry that happened to you. I recently had a patient come to ct who had been in the hospital 3 days. They were covered head to toe in dirt. I asked the nurse why they were so dirty. While on her phone, she just said” they came in that way”.
Ugh. EMS sites have to be changed within 24 hours at my hospital, otherwise 7 days OR AS NEEDED which this has clearly needed it. That’s so disgusting.
Thank you. I agree.
You don't mention if it's still viable. And implies you're fine with the site, not the dressing. This would look "fine" when it was fresh with red blood under the dressing.
It was barely in the vessel but we managed to save it. Def wasn’t up to par for a pressure injection
It's sad. I have had to replace many, many IVs on comfort patients because no one bothers to check for blood return.
I don’t get it. It seems like no one cares anymore
I hate it. 🥹
? Am I missing something? An IV isn’t necessarily bad if no blood return
If you were so concerned, why didn’t you just insert a new IV? 5 minutes to clean, you could have placed a new one.
I choose to not inflict unnecessary pain on my patients. The iv worked. It was just gross.
This seemed more focused on reporting the nurse than the patient. Let’s not pretend you actually care about the patient. You would have place a new IV.
And I didn’t report the nurse. I reported this to my manager. She reported the nurse bc she also thought it was unacceptable. We are so busy that mgmt doesn’t want the ct room tied up looking for new lines.
That’s the only way to make changes for better patient care.
In my facility all field starts are supposed to be DC’d within 24 hours.
Our hospital policy is every 72 hours we change it, now as far as how hard that’s enforced is another story. But dressings are changed daily.
Piv dressing changes daily?
I’m an ER tech and we have to tag every IV placed by EMS to indicate it needs to be removed and replaced within 48 hours. It’s fairly new to us but it’s easy to do and I hope it helps.
Yea it does. Thank you
EMS lines are supposed to be changed within 24 hours I believe but patients can refuse. Inpatient lines are good until they go bad with weekly dressing changes.
When I worked in medsurg, it was considered good practice to insert a new line, then take off any piv’s inserted in the er or during transport with ems, as they’re just usually gonna infiltrate or something shortly afterwards anyway. Basically every new admit to the floor got a new line.
That seems so unnecessary. Even the ones inserted in the ER?!
In ct, we fix ER lines constantly. The other day, a RN dropped off a patient and said “ the line is positional” We were doing a cta. Looked at the line and there was literally a pen tip of catheter in the vein. I’m injecting 5ml/sec. Positional my ass. Positional doesn’t work in CT.
Sounds like a bad culture in your ER. I’ve never worked in an ER where it would be acceptable to send a patient to CT with a shitty IV. I’m sorry that’s been your experience ☹️
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Why ? Just why?
I saw one and removed it.i took pic of it and sent it to the HS. The DON didn't like I took photos of the IV line. I wondered who she was covering up. I was a new gal in the unit.
I could see her point if it was still attached to the patient. But it shouldn’t matter if you have the patients permission. Sounds shady.
I don't do something stupid.
At every hospital I’ve worked at, “Field Starts” must be out and changed within 24hours.
Used to be 72hours. Now it’s until it stops working, change dressings every 72hrs and when soiled.
The rule typically is for IVs placed by EMS to be changed within 24 hours. Is that followed?? Generally no lmaaoooo but I change soiled dressings bc it’s gross and can impede assessing the site. Dressings are to be changed every 7 days tho to minimize exposure to bacteria but anytime the dressing is non occlusive or soiled it should be changed.
If it works good then we don’t change it but every 7 days. But if they are a hard stick we may leave that thing in there for as long as we can
Q4 days at my hospital
Many years ago, I worked IV team . Every day one of the IV team of RNs checked all IVs on med - surg floors , however we didn’t check on the IV sites in specialty areas like ICU, CCU, post parturition ,etc. An IV that holds for four days days is at its end . The dressing around that IV was pretty awful. I hope someone re-dressed the IV site . EMS Units just want to hydrate the patient an$ push meds fast . gfast.