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- A physician order is required for insertion and discontinuation of a peripheral IV.
- Exceptions in ED to follow CD and in an emergency situation on an inpatient unit.
- Select appropriate size catheter based on vein size, fluids to be administered, etc.
- Consider using ultrasound guidance for insertion by a Health Care Provider (HCP) competent in this skill.
- Assess daily for necessity. Remove promptly when no longer required.
- Assess site and patency once per shift (or visit if outpatient) and prior to intermittent infusions. If continuous infusion, site must be assessed:
- q4h during infusion
- q1-2 h in critically ill patients
- q30 minutes for vesicant infusion.
- In pediatric populations site assessment should be completed q1h.
- For patients older than 2 months, use chlorhexidine 2% and alcohol 70% solution for skin antisepsis.
- Clip or trim excessive hair around entire dressing area using clippers.
- Scrub the skin in grid pattern for at least 30 seconds. Allow the skin to dry completely before applying dressing.
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- For securement method avoid:
- Non-bordered transparent dressing (e.g., Tegaderm)
- Non-sterile tape
- If using tape, ensure it is sterile and single use when placed under the sterile dressing.
- Rolled bandage
- Skin-closure adhesive strip
- Gauze
- Use bordered securement dressing as per manufacturer’s instructions.
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- If inserted under non-aseptic conditions, replace vascular access device (VAD) within 24-48 hours.
- Flush line with syringe of preservative-free 0.9% Normal Saline (NS).
- If solution not compatible with 0.9% NS, flush with dextrose followed by 0.9% NS.
- After intermittent infusions.
- Between non-compatible solutions.
- Do not use IV solution bag for disconnection flush.
- If not in use, flush, confirm and document patency q24h or consider removal.
- Change dressing and cleanse site q7 days or more often if integrity of dressing is compromised or complications arise. Do not apply additional tape to secure.
- Re-site only if signs of complications and VAD is still needed for therapy.
- Scrub connections for 15 seconds prior to use or use engineered disinfectant caps on all connections (if available).
- Disinfectant caps are one time use and must be discarded when removed and a new one applied. Follow manufacturer’s instructions.
- All administration sets must be labelled with date, time and initials of HCP when initiated.
- Change administration sets:
- With the insertion of a new VAD.
- When the IV solution has changed.
- Immediately if contamination or integrity of the system/product has occurred.
- Otherwise change set as per table:
| Administration |
Frequency of Administration Set Change |
| Uninterrupted continuous infusion |
q7days |
| Intermittent infusions (includes both primary and secondary sets) |
q24h |
| Parenteral Nutrition |
q24h and with bag changes or disconnections (as per Parenteral Nutrition policy) |
| Lipids |
q12h |
| Propofol |
q6-12h |
| Blood and blood products |
After 4 units or 4 hours whichever comes first. Between different products. |
Canadian Vascular Access and Infusion Therapy Guidelines
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