INTRAVENOUS THERAPY
PURPOSE:

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To provide guidelines for:
Use of intravenous catheters of 3 inches or less for peripheral vein administration of
intravenous fluids and medications.
 Peripheral venous catheters
Use of catheters of longer than 3 inches or multi-lumen catheters for hyperalimentation,
hemodynamic monitoring and for administration of agents that cannot be administered as
effectively by other means.
 Midline catheters
 Nontunneled central venous catheters (CVC)
 PICC (Peripherally inserted central venous catheters)
 Tunneled central venous catheters
 Implantable catheters (ports)
 Umbilical catheters
Use of arterial catheters
 Peripheral arterial catheters
 Pulmonary arterial catheters
Placement of catheters
Removal of catheters from patients with unexplained fever or in whom local or systemic
vascular catheter-related sepsis is suspected.
POLICY:
I.
II.
Intravenous catheters less than 3 inches may be inserted by physician, certified RN or
supervised medical student. Percutaneous route is preferred rather than surgical cutdown.
A.
The risk of catheter-related phlebitis and infection rises when peripheral venous
catheters are left in place for longer than 72-96 hours. The date and time of
insertion of a peripheral venous catheter should always be written prominently on
the dressing and recorded in the patient's record. Select the site with lowest risk of
complications.
B.
An effort should be made to routinely replace peripheral venous catheters every
72-96 hours unless, in the judgment of the responsible physician, venous access is
so difficult as to make regular catheter changes unfeasible clinically or
impossible. Take out any non-essential lines.
Intravenous catheters longer than 3 inches or central venous catheters may only be
inserted by a physician experienced in the procedure or who is supervising a nonexperienced physician, medical student, or certified RN.
A.
Use proper hand hygiene during insertions, palpations, repairing, accessing or
dressing an intravenous catheter.
B.
Scrub the hubs, ports, and stopcocks with alcohol or an alcohol/CHG preparation
prior to access. Scrub the top and sides vigorously.
C.
Aseptic technique should be used during insertion and care. Sterile gloves should
be worn for insertion of arterial and central catheters.
D.
Location of placement of central line site should be chosen to reduce
complications of infections as well as potential mechanical complications.
Remove non-essential lines. Use a CVC with the minimal amount of lumens
needed to manage the patient clinically.
E.
Maximum sterile barrier precautions should be used for placement of CVC’s,
PICC’s and during guidewire exchange. This includes:
F.
G.
1.
Cap
2.
Mask
3.
Sterile gown
4.
Sterile gloves
5.
Large sterile drape.
Disinfect skin with appropriate antiseptic before insertion. Chlorhexidine/alcohol,
iodophor or 70% alcohol may be used. Povidone iodine must be allowed to dry
prior to beginning insertion.
Do not routinely replace central lines, PICC’s, hemodialysis catheters or
pulmonary arterial catheters to prevent catheter-related infections. Use clinical
judgment to evaluate appropriateness of line removal.
1.
III.
IV.
Umbilical venous catheters should be removed as soon as possible when
not needed but can be maintained aseptically for up to 14 days.
Site care and maintenance of peripheral and central venous catheters
A.
Dressings may be transparent, sterile, semi-permeable material or sterile gauze.
Replace dressing when it becomes wet, loose, soiled or to view site. Gauze
dressings can be replaced every 2 days and 7 days for transparent dressings. When
risk of dislodgement is a factor, time may be extended.
B.
Do not use topical antibiotic ointment or creams on insertion sites.
C.
Replace administration sets, add-ons and secondary sets no more frequently than
72 hours unless a problem develops. Tubing used to administer blood, blood
products or lipids should be changed every 24 hours.
D.
Routine periodic site care is not required for peripheral venous catheters unless
the dressing has become soiled or wet.
E.
Flushing or irrigation of the line should be avoided.
Use of arterial catheters – additional recommendations.
A.
Sterilize reusable transducers according to the manufacturer’s instructions when
disposable transducers are not available. Use disposable transducer assemblies
when possible.
B.
Replace these every 96 hours, including all components of the system (tubing,
flushing device and flush solution).
V.
C.
When accessing the system through a diaphragm, use antiseptic first.
D.
Do not use solutions with dextrose or parenteral nutrition through the circuit.
Removal of vascular catheters from patients with suspected sepsis
A.
Patients with unexplained fever or signs of systemic sepsis or any signs of local
inflammation of the catheter site should always have the catheter removed and
cultured by semiquantitative technique.
Exception: some central catheters may be left in place in septic patients to allow
for a trial of appropriate antimicrobial therapy to eradicate catheter related
infections. In general, if the subcutaneous tunnel is obviously infected and
certainly if the patient has not shown a satisfactory response to antimicrobial
therapy within several days and the catheter is thought to be the probable source
of septicemia, the catheter should be removed.
B.
Blood cultures should always be done if the patient has signs of sepsis. Ideally
cultures should be taken peripherally and via the line.
C.
A notation should be made in the chart concerning local inflammation, pain and
the presence or absence of pus upon compression of the puncture site after
removal of the catheter. A physician should always be informed if purulence is
expressed from the site.
D.
When contaminated fluid is suspected or found, the entire apparatus and unused
fluid should be saved and the infection prevention department immediately
notified.
Major areas of emphasis, as noted in CDC Guidelines for Prevention of Intravascular
Catheter-Related Infections include:
1.
2.
3.
4.
5.
Reference:
Education and training of personnel who insert and maintain catheters is
essential.
Maximum sterile barriers should be used when inserting central venous
lines.
2% chlorhexidine preparation for skin antisepsis is recommended.
Routine replacement of central venous catheters should be avoided.
Antibiotic/antiseptic impregnated catheters may be considered for use if
infection rate is high after institution of recommendations above.
CDC, 2011 Guidelines for the Prevention of Intravascular Catheter-Related
Infections, http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html
Catheters used for venous and arterial access
Catheter type
Entry site
Length
Comments
Peripheral venous
catheters
Usually inserted in veins of
forearm or hand
Peripheral arterial
catheters
Usually inserted in radial
artery; can be placed in
femoral, axillary, brachial,
posterior tibial arteries
Inserted via the antecubital
fossa into the proximal
basilic or cephalic veins;
does not enter central veins,
peripheral catheters
>3 inches; rarely
associated with
bloodstream infection
>3 inches; associated
with bloodstream
infection
Phlebitis with prolonged
use; rarely associated with
bloodstream infection
Low infection risk, rarely
associated with
bloodstream infection
3 to 8 inches
Anaphylactoid reactions
have been reported with
catheters made of
elastomeric hydrogel;
lower rates of phlebitis
than short peripheral
catheters.
Account for majority of
CRBSI
Midline catheters
Percutaneously inserted into
central veins (subclavian,
internal jugular, or femoral)
Inserted through a Teflon®
introducer in a central vein
(subclavian, internal jugular,
or femoral)
≥8 cm, depending on
patient size
Inserted into basilic,
cephalic, or brachial veins
and enter the superior vena
cava
Implanted into subclavian,
internal jugular, or femoral
veins
≥20 cm depending on
patient size
Totally Implantable
Tunneled beneath skin and
have subcutaneous port
accessed with a needle;
implanted in subclavian or
internal jugular vein.
≥8cm depending on
patient size
Umbilical catheters
Inserted into either umbilical
vein or umbilical artery
≥6 cm depending on
patient size
Nontunneled central
venous catheters
Pulmonary artery catheters
Peripherally inserted
central venous catheters
(PICC)
Tunneled central venous
catheters
Reference:
≥20 cm depending on
patient size
≥8 cm depending on
patient size
Usually heparin bonded;
similar rates of
bloodstream infection as
CVC’s; subclavian site
preferred to reduce
infection risk.
Lower rate of infection
than nontunneled CVC’s
Cuff inhibits migration of
organisms into catheter
tract; lower rate of
infection than nontunneled
CVC’s
Lowest risk for CRBSI;
improved patient selfimage; no need for local
catheter-site care; surgery
required for catheter
removal
Risk for CRBSI similar
with catheters placed in
umbilical vein versus
artery
CDC, 2011 Guidelines for the Prevention of Intravascular Catheter-Related
guidelines-2011.html Infections, http://www.cdc.gov/hicpac/BSI/BSI-