If a patient requires medicines or fluids, assess the patient to identify the most appropriate route of administration for their clinical needs before starting therapy. Consider whether another route of administration (for example, the oral, intramuscular, subcutaneous, rectal, intra-osseous or intra-peritoneal route) is appropriate, before using the IV route.
If all other routes of administration have been excluded and IV access is needed, assess whether peripheral or central venous access is appropriate by considering the:
- Patient’s medical history, age, clinical and vascular condition
- Expected duration of therapy
- Likelihood of repeated or prolonged administration of vesicants or irritants such as vancomycin, flucloxacillin, potassium or certain types of chemotherapy
- Patient’s history of infusion therapy and whether there were complications associated with its use – for example, difficulty locating suitable veins
- Availability of appropriate insertion sites and the likelihood of first-time insertion success
- Position of the patient during any planned procedures
- Patient’s lifestyle, body image, and preferences for therapy and location of the device, and whether therapy can be delivered safely in accordance with their preferences
- Availability of resources and ability to care for the device.
Insertion of a PIVC pre-emptively may be appropriate for patients at risk of clinical deterioration. Collection of pathology samples is not a valid reason to insert a PIVC; although this often happens in emergency departments, it can lead to unused PIVCs being left in. If frequent sampling is required, exceptions may be considered after individual assessment; examples include, fourth hourly troponin levels, to optimise patient comfort, or if there is difficult venous access. PIVCs should not be used to obtain blood cultures as this leads to an increased risk of contamination to the blood culture and PIVC.
By discussion with the patient, ascertain that they understand the need for IV therapy, especially if multiple device options are available, specific clinical issues about the therapy need to be raised, or the patient has concerns.