Optimizing Intravenous Line Care: A Guide for Nurses

Abstract

Intravenous (IV) catheterization is a cornerstone of modern medical care, with millions of peripheral intravenous (PIV) and central venous catheters (CVCs) placed annually in the United States. While these devices are essential for administering medications, fluids, and nutrition, they also carry significant risks, including infections and mechanical complications. This article provides a comprehensive guide for nurses on optimizing IV line care based on current evidence-based guidelines and research. For PIVs, site selection should prioritize the forearm and upper extremities, avoiding areas of flexion. Skin preparation involves using chlorhexidine gluconate in alcohol, allowing the site to dry completely before insertion. Proper dressing and stabilization using engineered stabilization devices or medical adhesive securement systems are crucial for maintaining catheter integrity and preventing complications. Regular assessment, at least every four hours, is essential to monitor for signs of infection, infiltration, or dislodgement. PIV catheters should be removed when clinically indicated rather than on a fixed schedule. Bundled strategies, including staff education and strict adherence to best practices, have been shown to significantly reduce PIV-related bloodstream infections. For CVCs, maximum sterile barrier precautions and ultrasound guidance during insertion are critical. Skin preparation with chlorhexidine gluconate and the use of chlorhexidine-impregnated dressings are recommended to minimize infection risks. Daily assessment and prompt removal when the CVC is no longer necessary are crucial. Future research, such as the CLEAN 3 Protocol Study, aims to address gaps in knowledge surrounding antisepsis practices for PIVs and strengthen evidence-based guidelines for optimal IV line care.