What is the recommended frequency for changing a peripheral IV catheter?
Peripheral IV catheters need to be assessed regularly and removed promptly when they are no longer needed, are causing pain, or are not working properly. An IV that is in use and functioning well can remain in place. Don't leave an IV in place just in case it might be needed in a day or so.
Ref: Webster J, Osborne S, Rickard CM, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD007798. DOI: 10.1002/14651858.CD007798.pub4.
Should pain relief be given for insertion of a peripheral intravenous catheter?
Yes. Bond et al's (2016) systematic review concluded that the pain of applying any local anaesthetic is less than that of unattenuated cannulation. Pain relief should be standard practice.
Bond M, Crathorne L, Peters J, Coelho H, Haasova M, Cooper C, Milner Q, Shawyer V, Hyde C, Powell R. (2016) First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis. BMC Anesthesiology, 16, 1 DOI: 10.1186/s12871-016-0252-8
Griffith et al's (2016) Cochrane systematic review and meta-analysis pooled the results from 8 clinical trials involving 848 participants that investigated the use of vapocoolant sprays or "cold sprays" to reduce pain on the insertion of the IV catheter. The pooled results provide evidence that the use of vapocoolant spray reduces pain during IV insertion without increasing the difficulty of this procedure.
Ref: Griffith RJ, Jordan V, Herd D, Dalziel SR. Vapocoolants (cold spray) for pain treatment during intravenous cannulation. Cochrane Database Systematic Reviews 2016 Issue 4. Art. No.CD009484.doi:10.1002/14651858.CD009484.pub2
What's the recommendation for flushing practice?
In lieu of much needed trial research, clinicians and organisations could make efforts to standardise and streamline flushing practice in order to minimise inconsistencies and optimise documentation. The USA's Infusion Nurses Society and many local guidelines recommend:
Additionally, a record of site/device assessment and/or flushing would enhance best practice.
What rate is best to 'keep vein open' for a CVAD?
'Keep vein open (KVO) is another area of disagreement and dispute. There are no evidence-based guidelines on how much fluid should be infused to keep a catheter patent. It varies substantially in anecdotal reports from 5 mls/hr to 50 mls/hr! 5 mls/hr could be insufficient, but even 20 mls/hr might be too much for a patient with a heart condition.
In a recent article from Canada (Paquet & Marchionni, 2016), they conducted a literature review of the practice of KVO and surveyed their staff to find out what KVO practices nurses were using. The authors state: "The most surprising finding of the literature review was the paucity of more recent studies or discussions about this ubiquitous practice. In reviewing the articles, none offered a comparison of infusion rates in terms of efficacy for maintaining patency, nor were there any comparisons in the adult population of the use of KVO versus saline locking comparing catheter longevity." Furthermore, "INS indicates that a standard infusion rate, a so-called one size fits all, cannot be determined and needs to take into account the age of the patient, fluid and electrolyte balance, and the presence of comorbidities."
In this article, the authors chose to go with 10 mls/hr, but they rightly acknowledge there is no concrete evidence for doing so.
Ref: Paquet F, Marchionni C. What Is Your KVO? Historical Perspectives, Review of Evidence, and a Survey About an Often Overlooked Nursing Practice. J Infus Nurs. 2016;39(1):32-