Peripheral IVs and Extended Dwell PIVs

Peripheral IVs and Extended Dwell PIVs, which are ultrasound guided, are the most common standard lines used for establishing vascular access. These are not central lines and this page describes IV Access, IV Mobile Services, IV Sites, IV Extravasations, and clinically appropriate uses for both of these lines.

IV Access

| IV Access Services

IV Access and IV Access Services are provided by nurses, PICC Nurses, PICC Services companies, and Vascular Access Services companies. IV Access typically describes IVs, also known as Peripheral IVs and PIVs, including both basic and extended dwell PIVs. IV Access Services is not typically used to describe additional vascular access services of Midlines and PICCs, as those are usually described by the term PICC Services. Furthermore, PICC Services typically do not include advanced lines such as Small Bore Internal Jugular Lines, Femoral Lines, and Axillary Lines as well as Large Bore Lines including Vas Caths for Dialysis and Quad Lumen Lines, as such is usually referred to as Vascular Access Services. Regardless, IV Access Services are critical to patient care as virtually all care starts with access whether IV Access, a Midline, or a Central Line.
Peripheral IV

Peripheral IV

IV Mobile

| IV Access Company

IV Mobile may include a range of mobile nursing companies that provide on-call, on-demand, and on-site IV Access Services. Each may sometimes be called an IV Access Company. IV Mobile companies may provide the IV Access and may provide additional services and assist in the infusion of medication or fluids. Generally, if the IV Nurse is a PICC Nurse, meaning able to insert or place Midlines and PICCs, then there is a greater likelihood that such PICC Nurse will leave after IV Access is obtained leaving the patient in the care of the infusion nurse. IV Mobile companies vary; some may consist of 1099 contractors that do not serve hospitals and others may consist of highly trained, certified employees that are hospital credentialed and serve patients wherever they are located. Not all IV Mobile companies are the same and at Vascular Wellness, we pride ourselves in our training, education, skill-verification, credentialing and our ability to place standard and advanced lines and perform at the highest levels of Vascular Access.

IV Access Sites

| IV Catheter Types

IV Access Sites can vary but generally, the IV Access Site is the forearm, where it starts and ends and access to a peripheral vein is obtained. IV Catheter Types similarly vary but generally, the IV Catheter is a short, small, plastic tube that is placed in the IV Access Site. Having said that, in the case of both Peripheral IVs and Extended Dwell PIVs, both upper arms and right side of neck should not be accessed as IV Access Sites in order to preserve the insertion sites in case needed for a Midline, PICC or Internal Jugular Line. Essentially, whenever performing vascular access, and regardless of the IV Catheter Types, care should be taken to preserve as much future flexibility as reasonably possible. Further, even though IVs are common lines, the skin must be cleaned in advance of the procedure and care and maintenance is important to help avoid infection.

Radiopharmaceutical Extravasations

| Radiopharmaceutical Infiltrations

Radiopharmaceutical Extravasations or Infiltrations describe specific situations in nuclear medicine caused by IVs not being properly placed in the veins at the IV Access Sites causing radioactive fluid to go into the skin instead of the vein. This is a great risk and concern in the area of nuclear medicine as the “fluid” is a radiopharmaceutical or radioactive isotope. Incorrect injection that results in fluid leakage into the arm tissue can cause significant adverse consequences including poor imaging, subpar patient treatment plans and care, and patient harm. Unlike other infiltrations of antibiotics, medication and other fluids, the potential adverse consequences of radiopharmaceuticals is much greater. Vascular Wellness is strong supporter of improving IV Access specifically in the area of nuclear medicine through additional training and education, and is a corporate sponsor of Patients For Safer Nuclear Medicine.

To learn more about Radiopharmaceutical Extravasations, please visit: Why does Nuclear Medicine greatly depend on proper Vascular Access? and Radiopharmaceutical Extravasations: Hazards…Prevention – Webinar Review.

nuclear medicine

Nuclear Medicine

Peripheral IV

| PIV

Peripheral IV, as stated above, is the most basic and least intrusive method for obtaining Vascular Access provided it is clinically indicated and appropriate, which means the following:
• Neutral pH IV medications or fluids (pH >5 or <9)*
• IV medication or fluid Osmolality <900 *
• Successful PIV access in < 3 attempts
• Venipuncture appropriate for routine lab work
• Anticipated PIV need <5 days**

* Infusion Nursing Standards of Practice, Journal of Intravenous Nursing, (15) January-February 2011.
** Centers for Disease Control and Prevention. (2011). Guidelines for the prevention of intravascular catheter-related infections. Retrieved January 2015.

After 3 unsuccessful Peripheral IV attempts, an Extended Dwell Peripheral IV should be considered. 

Extended Dwell Peripheral IV

Extended Dwell Peripheral IV

Extended Dwell Peripheral IV

| Extended Dwell PIV

Extended Dwell Peripheral IV, which is Ultrasound Guided, is the next step for Vascular Access if clinically indicated or a Peripheral IV is not successful. Indications of use include:
• Diminished Access Insertion Sites for PIV
• History of difficult PIV Access
• More than 3 unsuccessful PIV Access attempts
• Veins deeper than 2 cm
• Infusion or fluids needed for up to 29 days
• Short term bridge to therapy prior to Midline or Central Access (e.g., PICC)
• Improved blood return over PIV for lab sampling

Midline

A Midline vascular access device is generally the next treatment option if a PIV or Extended Dwell PIV is not clinically indicated. See Midlines for more information.

Midline Catheter

Midline Catheter

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Vascular Wellnesssm provides clinical vascular access nursing services at the bedside across the Southeast to a diverse client base including Tertiary Hospitals, Community Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Surgical and Outpatient Centers,  Hospice, and At-Home care.

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