Intravenous (IV) therapy delivers fluids, medications, and nutrients directly into the bloodstream through a flexible catheter inserted into a vein. Understanding how long an IV line can safely remain in place is important for preventing complications and ensuring the line remains functional. The duration an IV stays in depends heavily on the type of catheter used and the patient’s overall condition.
Standard Duration for Peripheral IVs
The most common type of IV access is the peripheral intravenous (PIV) catheter, a short tube placed in a superficial vein, usually in the arm or hand. Historically, guidelines recommended routine replacement of these catheters every 72 to 96 hours. This practice aimed to reduce the risk of phlebitis (inflammation of the vein) and bacterial infection.
Modern clinical practice has largely moved away from this fixed-schedule replacement for adults. The Infusion Nurses Society (INS) now recommends that PIVs be replaced only when there is a clinical indication of failure or complication. Research shows that replacing a working PIV only when necessary does not significantly increase the rate of infection or phlebitis compared to the routine change. This shift helps preserve the patient’s veins by avoiding unnecessary needle sticks.
A PIV that is functioning well and shows no signs of complication can often safely remain in place beyond the traditional four-day limit. The decision to keep the line is based on a daily assessment of the insertion site. This approach minimizes patient discomfort and conserves resources, but it requires diligent monitoring. If a PIV is inserted during an emergency situation or without optimal sterile technique, it is typically replaced within 24 to 48 hours to mitigate the higher risk of infection.
Recognizing When an IV Site Fails
Certain signs and symptoms necessitate the immediate removal of an IV and rotation to a new site, regardless of how long it has been in place. The most common local complication is infiltration, which occurs when the IV fluid leaks out of the vein into the surrounding tissue. Signs of infiltration include swelling, coolness to the touch, and the skin appearing pale or blanched around the insertion site.
Another frequent complication is phlebitis, characterized by inflammation of the vein wall. A patient may report pain and tenderness along the path of the vein. Upon inspection, the site often appears warm and red, and the vein may feel firm or “cord-like” beneath the skin. Phlebitis can be caused by mechanical irritation from the catheter, the chemical nature of the infused medication, or an infection.
Infection at the insertion site requires immediate attention and removal of the catheter. Local signs include pronounced redness, swelling, and the presence of pus or purulent drainage at the entry point. Systemic symptoms, such as a fever or chills, indicate the infection may be spreading into the bloodstream. An occlusion, or blockage, is indicated when the fluid stops flowing or when an infusion pump triggers a high-pressure alarm, signaling resistance in the line.
Duration Differences for Central Lines
Specialized devices, known as central venous access devices (CVADs), are used for patients requiring treatment over weeks, months, or even years. CVADs are named because the catheter tip rests in a large vein near the heart. The duration a CVAD remains in place is determined by the patient’s treatment plan and the absence of complications, not a simple time limit.
A Peripherally Inserted Central Catheter (PICC) is a common CVAD inserted into an arm vein, though it is much longer than a PIV. PICC lines are often used for extended courses of intravenous antibiotics, chemotherapy, or nutrition, remaining in place for several weeks to many months. Another type is the tunneled catheter, such as a Hickman or Broviac line, which is surgically placed under the skin of the chest before entering a vein.
For patients needing intermittent access over the longest periods, an implanted port, or Port-a-Cath, may be used. This device consists of a small reservoir placed completely under the skin, accessed with a special non-coring needle when treatment is needed. Implanted ports can remain functional for years, providing a durable solution for long-term therapy while minimizing the risk of infection when not actively being used.