Routine use: inspect, access and flush

Quality statement 8

A patient’s PIVC and insertion site is inspected by a clinician for signs of complications at least once per shift or every eight hours, when accessing the device, and if the patient raises concerns. Standard precautions including aseptic technique are used when performing site care and accessing the PIVC. Patency is checked and flushing is performed at intervals according to local policy to assess device function and minimise risk of device failure.

Purpose

To reduce the risk of PIVC device failure and preserve vessel health by ensuring that PIVCs are regularly reviewed and access is maintained using standard precautions, including aseptic technique. PIVCs are also flushed at intervals according to local policy to maintain patency, reduce the risk of blockage, and prevent mixing of incompatible medicines or solutions.

What the quality statement means

For patients

To make sure your PIVC continues to function properly, your clinician will check your PIVC at least once every shift or every eight hours, each time they use the device, and if you raise any concerns about it.

Specifically, your clinician will check:

  • For pain, swelling or redness of your skin around your PIVC
  • For any signs of infection, including fever (feeling hot, cold or shivery)
  • For leaking or blockage
  • That your PIVC is still firmly in place
  • That the dressing covering the insertion site has not become bloodstained, wet or loose
  • Whether anything else about your PIVC is concerning you.

Your clinician will provide regular care to prevent complication from developing, but it is important that you tell your clinician if you notice any of these problems.

Each time your PIVC needs to be touched, your clinician will thoroughly clean their hands and take precautions to make sure the PIVC stays clean. They will check that your PIVC is flowing properly (patency), and will also flush it from time to time to make sure it does not get blocked.

It is important that you do not touch, fiddle with or move your PIVC.

For clinicians

Routinely inspect the PIVC and insertion site, for signs of complications that can lead to device failure. This should happen at least once per shift (or per eight hours) and when accessing the device, or if the patient raises any concerns about it. More frequent inspection may be required for some patients, or according to local policy, for example for paediatric patients. In particular, check:

  • For signs of pain, swelling or redness at the insertion site, by visual inspection through the transparent dressing and gentle palpation through the dressing
  • The condition of the patient’s veins, and whether they have become hardened or thrombosed
  • For signs of localised or systemic infection; if either are confirmed, report as per local policy in an incident management system
  • For leakage of fluid from the insertion site, signs of occlusion, infiltration or extravasation
  • Whether the PIVC remains appropriately dressed and secured.

As part of the review, ask the patient questions to check whether they are tolerating their PIVC, and whether they understand why it is needed and the treatment they are having. Explain the reasons for checking the device, and the signs and symptoms you are looking for that might suggest that problems are developing.

Ask the patient if they have any concerns associated with the use of their PIVC and deal with these concerns. Check that the patient knows what signs and symptoms to report, including local site complications such as pain, redness, swelling, skin irritation or fever. Advise about the importance of telling their clinician if they think complications are developing so that they can be addressed immediately.

Use standard precautions, including aseptic technique, when accessing the PIVC or performing site care to help reduce the risk of PIVC-associated infections. Decontaminate needleless connectors before and after access with 70% alcohol or other solution recommended in current evidence-based or best-practice guidelines, and allow to fully air dry.

Flush the PIVC using a solution recommended in current evidence-based or best-practice guidelines and at intervals according to local policy, to maintain line patency, reduce the risk of blockage, and prevent mixing of incompatible medicines or fluids.

For health service organisations

Ensure that evidence-based policies and procedures are in place outlining what is needed to access, maintain and flush a PIVC. Ensure that equipment is available at the point of care to ensure that hand hygiene and aseptic technique are maintained every time the PIVC is reviewed, accessed or flushed.

For patients

To make sure your PIVC continues to function properly, your clinician will check your PIVC at least once every shift or every eight hours, each time they use the device, and if you raise any concerns about it.

Specifically, your clinician will check:

  • For pain, swelling or redness of your skin around your PIVC
  • For any signs of infection, including fever (feeling hot, cold or shivery)
  • For leaking or blockage
  • That your PIVC is still firmly in place
  • That the dressing covering the insertion site has not become bloodstained, wet or loose
  • Whether anything else about your PIVC is concerning you.

Your clinician will provide regular care to prevent complication from developing, but it is important that you tell your clinician if you notice any of these problems.

Each time your PIVC needs to be touched, your clinician will thoroughly clean their hands and take precautions to make sure the PIVC stays clean. They will check that your PIVC is flowing properly (patency), and will also flush it from time to time to make sure it does not get blocked.

It is important that you do not touch, fiddle with or move your PIVC.

For clinicians

Routinely inspect the PIVC and insertion site, for signs of complications that can lead to device failure. This should happen at least once per shift (or per eight hours) and when accessing the device, or if the patient raises any concerns about it. More frequent inspection may be required for some patients, or according to local policy, for example for paediatric patients. In particular, check:

  • For signs of pain, swelling or redness at the insertion site, by visual inspection through the transparent dressing and gentle palpation through the dressing
  • The condition of the patient’s veins, and whether they have become hardened or thrombosed
  • For signs of localised or systemic infection; if either are confirmed, report as per local policy in an incident management system
  • For leakage of fluid from the insertion site, signs of occlusion, infiltration or extravasation
  • Whether the PIVC remains appropriately dressed and secured.

As part of the review, ask the patient questions to check whether they are tolerating their PIVC, and whether they understand why it is needed and the treatment they are having. Explain the reasons for checking the device, and the signs and symptoms you are looking for that might suggest that problems are developing.

Ask the patient if they have any concerns associated with the use of their PIVC and deal with these concerns. Check that the patient knows what signs and symptoms to report, including local site complications such as pain, redness, swelling, skin irritation or fever. Advise about the importance of telling their clinician if they think complications are developing so that they can be addressed immediately.

Use standard precautions, including aseptic technique, when accessing the PIVC or performing site care to help reduce the risk of PIVC-associated infections. Decontaminate needleless connectors before and after access with 70% alcohol or other solution recommended in current evidence-based or best-practice guidelines, and allow to fully air dry.

Flush the PIVC using a solution recommended in current evidence-based or best-practice guidelines and at intervals according to local policy, to maintain line patency, reduce the risk of blockage, and prevent mixing of incompatible medicines or fluids.

For health service organisations

Ensure that evidence-based policies and procedures are in place outlining what is needed to access, maintain and flush a PIVC. Ensure that equipment is available at the point of care to ensure that hand hygiene and aseptic technique are maintained every time the PIVC is reviewed, accessed or flushed.

Read quality statement 9 - Review ongoing need