How long can a peripheral IV catheter remain in place with proper care?

According to CDC guidelines, peripheral IV catheters may be kept in place for up to 96 hours in adults with proper care and maintenance. In pediatric patients, catheters may remain longer until the line is no longer patent or demonstrates complications. Routine rotation every 96 hours is not indicated in children due to increased anxiety from needle sticks.

What signs indicate a peripheral IV site has complications and needs discontinuation?

Signs of IV complications include redness, swelling, bruising, increased temperature, bogginess, tenderness, or pain at the insertion site. Leaking or swelling during flushing, difficulty injecting fluid, or patient-reported pain also indicate the site is no longer appropriate. When complications are detected, discontinuing intravenous fluids and a peripheral intravenous line is necessary and the primary care provider must be notified.

What is the proper technique for cleansing a needleless injection site before flushing?

Open an alcohol wipe and hold the needleless injection site with your non-dominant hand. Wrap the alcohol wipe around the site and scrub with friction and intent for 15 seconds, as if juicing an orange. Continue holding the site without contaminating it while it dries completely before attaching the saline syringe.

How do you assess a peripheral IV catheter dressing for proper condition?

Inspect the transparent catheter dressing to ensure it is clean, dry, and securely adhered to the skin around the insertion site. If the dressing is loose, wet, or soiled, change it using aseptic technique. A properly maintained dressing protects the insertion site and helps prevent infection and contamination.

What complications can regular IV assessment and flushing help prevent?

Regular assessment and flushing prevent infiltration, phlebitis, infection, extravasation, and catheter dislodgement. IV maintenance and flushing preserves line patency and reduces the risk of occlusion, thrombosis, and thrombophlebitis. Routine care ensures IV therapy can continue safely without interruption or patient harm.

What should be documented after assessing and flushing a peripheral IV line?

Document the date, time, location, and findings of the PIV assessment in the patient's electronic health record. Record the absence of redness, swelling, irritation, and confirm the dressing is clean, dry, and intact. If complications are present, document them specifically and notify the primary care provider immediately.

How do you prepare a normal saline flush syringe before attaching it to the IV line?

Open the saline flush syringe package and remove the cap, placing it upright on the counter. Turn the plunger to break the seal, then push gently while holding the syringe upright to expel air. Screw the cap back on carefully to maintain sterility, then place the syringe on the counter until ready to attach to the needleless port.

评估与冲洗外周静脉导管

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1. 一般操作注意事项（在房间内与患者一同回顾）。

与患者接触前，始终先用肥皂和温水彻底洗手。若双手无明显污物，可使用手部消毒剂，并充分揉搓。
在床旁计算机上，查阅患者的病史，并确认患者是否仍需保留静脉通路。
查阅医嘱执行记录（MAR）中的维持性静脉输液医嘱。
1. 若患者当前正通过静脉通路输注维持性液体，需确认其是否仍需继续接受静脉输液治疗。可通过评估患者的出入量平衡、生命体征、皮肤弹性及黏膜状况，并结合血清实验室检查结果进行判断。
离开患者病房时，按上述方法（步骤 1.1）再次洗手。

2. 在药物准备区域，取10 mL生理盐水冲洗液和酒精棉片。

3. 评估并冲洗患者的静脉输液管路。首次进入患者病房时，按照步骤1.1所述，将物品放在台面上并洗手。

评估外周静脉留置针穿刺部位。
1. 检查静脉导管穿刺部位是否存在发红、肿胀或瘀伤。发红可能提示刺激、炎症、感染或血栓形成。瘀伤可能提示已形成血肿，并可能对周围组织造成损伤。
2. 评估透明导管敷料的状况。敷料应保持清洁、干燥，并牢固粘附于静脉导管穿刺部位周围的皮肤。若敷料松动、潮湿或污染，应采用无菌技术更换。
3. 评估是否存在压痛和肿胀。
  1. 轻柔触诊静脉导管穿刺部位周围区域，并询问患者该区域是否有压痛或疼痛。压痛可能提示穿刺部位已发生炎症或感染。
  2. 用一只手轻柔触诊静脉导管穿刺部位周围区域，同时用另一只手同步触诊对侧肢体相同区域，进行双侧比较。
  3. 触诊时，评估局部温度（i.e., 升高或降低）、皮肤质地（i.e., 柔软、松软或紧绷）以及肿胀情况（i.e., 两侧肢体大小是否存在差异）。温度升高可能提示炎症或感染，而温度降低和组织松软可能提示液体外渗。上述任一情况均表明该外周静脉留置针必须停止使用。
冲洗外周静脉留置针。
1. 在进行下一步操作前，按照步骤1.1所述方法洗手，并戴上清洁手套。
2. 准备0.9%氯化钠注射液冲洗液。
  1. 打开一支0.9%氯化钠注射器的包装。用惯用手握住注射器，非惯用手拧下并取下注射器帽。将帽口朝上放置于桌面/台面，注意避免污染帽端。轻轻旋转活塞以打破密封。
  2. 用非惯用手竖直握住注射器，惯用手轻推活塞排出空气。用惯用手拾起注射器帽，注意避免污染帽端，然后轻轻将帽拧回0.9%氯化钠注射器上。将0.9%氯化钠注射器放置于桌面。
3. 清洁外周静脉留置针无针接头部位。
  1. 打开一个酒精棉片包装，并用惯用手持握。
  2. 用非惯用手固定外周静脉留置针无针接头部位，将酒精棉片包裹其上，用力摩擦擦拭至少15秒（i.e., 如同挤压橙子般施加力度）。继续用非惯用手持握该部位，待无针接头自然干燥，注意避免触碰已消毒区域。
用生理盐水冲洗导管。
1. 继续用非惯用手拇指和食指夹持外周静脉留置针无针接头部位，用另一只手取0.9%氯化钠注射器，将注射器帽夹于非惯用手的中指与无名指之间，然后拧下帽盖。
2. 将注射器轻轻推入无针接头端口中心部位，并顺时针旋转拧紧。
3. 轻轻推动塑料夹片将其打开，以松开外周静脉留置针夹。用惯用手的中指与食指夹持0.9%氯化钠注射器，以惯用手拇指轻推活塞，冲洗静脉通路。
4. 在推动活塞的同时，观察静脉穿刺部位是否有渗漏、穿刺部位是否肿胀以及推注是否顺畅。询问患者在推注0.9%氯化钠注射液过程中是否感到疼痛。若出现上述任一情况，或推注困难，则表明该静脉通路已不再适用，应予以更换。
5. 继续用非惯用手食指和拇指夹持无针接头部位，轻柔逆时针拧下0.9%氯化钠注射器。
  将使用过的酒精棉片和0.9%氯化钠注射器丢弃至垃圾桶中。

4. 在患者的电子健康记录中记录外周静脉置管部位的评估情况。

在患者的电子健康记录中，记录外周静脉留置针穿刺部位评估的日期、时间及部位。记录评估结果。
1. 若穿刺部位无并发症，应记录外周静脉留置针穿刺部位无红肿、肿胀及刺激症状。记录敷料清洁、干燥且完整，外周静脉通路通畅，冲管顺畅。
2. 若穿刺部位出现并发症，应记录具体发现及患者反应。应停止使用并更换外周静脉留置针。应通知患者的初级保健提供者，并采取适当措施以防止进一步并发症。

5. 离开病房后立即洗手。