In this section
Note: This guideline is currently under review.
Definition of terms
Peripheral intravenous catheters (PIVC) are the most commonly used intravenous device in hospitalised patients. They are primarily used for therapeutic purposes such as administration of medications, fluids and/or blood products as well as blood sampling.
The aim of this guideline is to provide an outline of the ongoing maintenance and management of the PIVC for patients in hospital, outpatient, and home healthcare settings. For information related to insertion of PIVC, please refer to
intravenous access guideline . Nurses who are deemed competent in IV insertion could continue to insert PIVC in consultation with NUM/CSN’s.
Patient and IV site assessments should be done on a regular basis.
PIVC assessment includes:
Administration of intravenous fluid, drug infusions or blood products
a) Continuous infusion of IV fluids
Assessment and documentation of findings are to be completed hourly to determine effective delivery of prescribed medications and fluid.
Infusion Pump PressurePressure limit defaults for intravascular infusion pumps are programmed by Biomedical Engineering, based on the manufacturer’s recommendations.
Upper limit infusion pump pressure can be manually increased with clinical discretion to accommodate:
If pump pressure exceeds the recommended limits, check the patency of the PIVC.
b) Administration of bolus/loading doses:
Drugs administered via PIVC may be
The most appropriate method should be selected depending on volume of diluent required, patient condition, fluid balance and intended rate of delivery.
Drugs administered via:
Attach a completed drug label detailing the drug, dose, diluent, volume of diluent, date, time and signature of the nurse and the staff who double checked.
Access PIVC only after cleaning the access port and scrub the hub.
For intermittent infusions, IV lines which are disconnected are to be discarded between infusions. Ensure the cannula is flushed with normal saline once the giving set is disconnected from the cannula. For Opioid infusion bolus refer to the specific guidelines:
Children’s Pain Management Service (CPMS)(opioid infusion guideline)
Administering blood products:
Flushing of PIVC’s
Change of PIVC dressing and securement of cannula:
Change of Extension sets
IV Fluid Considerations via Peripheral IV line
Which Fluids and how much fluids to use
Refer to the Intravenous Fluids Clinical Practice Guideline:
Fluid bag and infusion changes:
Table 1.Changing IV bags and lines
IV line change
No additives in infusion
Every 7 days
Every 24 hrs in neonates
Every 7 days
Additives in infusion
Every 24 hours
Lipid or lipid containing parenteral nutrition
Every 4 hours
Up to 12 hours
Removal of PIVCs:
There is no evidence for routine replacement of PIVC unless clinically indicated. PIVC’s should be maintained with regular assessment and documentation of complications.
The possible reasons for removal of PIVC’s include a number of complications which range from infiltration, extravasation, phlebitis, occlusion, dislodgement and migration. Once the child’s treatment is over, the PIVC should be removed to avoid any additional complications.
Management of complications
There are a range of complications that could occur with the presence of a PIVC in insitu. Some of these complications can be prevented by the correct use of aseptic technique for insertion and maintenance as well as assessing the device as indicated.
Common complications are:
The evidence table can be found here.
Please remember to read the
The development of this nursing guideline was coordinated by Mercy Thomas, Nursing Educator, and approved by the Nursing Clinical Effectiveness Committee. Updated December 2018.