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Adjustments to Peripherally Inserted Vascular Access Device Orders – Adult – Inpatient/Emergency Department [7]

Adjustments to Peripherally Inserted Vascular Access Device Orders – Adult – Inpatient/Emergency Department [7] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Practice Protocols


Practice Protocol Number:   7         
 
Practice Protocol Title: 
Adjustments to Peripherally Inserted Vascular Access Device Orders – Adult – Inpatient/Emergency Department 
 
Practice Protocol Applies To: 
Adult patients with an order for peripheral intravenous (PIV) or midline vascular access device placement who 
meet criteria for substitution.    
 
Target Patient Population: 
UW Health adult inpatients and Emergency Department patients 
Not Included:  The American Center 
 
Practice Protocol Champion: 
Christopher Crnich, MD – Department of Medicine, Infectious Disease 
Linda Stevens, DNP, RN‐BC, CPHQ, CSPHP – Director, Nursing Quality and Safety  
 
Practice Protocol Reviewers: 
Dawn Berndt, CNS – Nursing Practice Innovation 
Emily Wilhelmson, CNS – Nursing Program Development 
Troy Betts, RN – Nursing Education and Development 
Kristin Strampe, RN – Nursing Manager, Venous Access Team 
Cindy Gaston, PharmD – Drug Policy Program 
Sara Shull, PharmD – Drug Policy Program 
 
Responsible Department: 
Department of Nursing 
 
Purpose Statement: 
The purpose of this protocol is to provide nurses a framework to determine the most appropriate peripheral
vascular access for the patient.
 
Who May Carry Out This Practice Protocol: 
Registered Nurses (RNs)  
 
Guidelines for Implementation: 
1. This protocol is initiated when an order is entered for a peripheral venous access device in an adult patient.
2. The RN assesses the patient and determines the appropriate device for placement.
3. Indications for a peripheral intravenous (PIV) access device:
3.1. Appropriate PIV indications:
3.1.1. Expected length of stay is less than 5 days
3.1.2. Medications administered do not need central venous access (not needing a central line)
administration. Refer to: Intravenous Administration of Formulary Medications – Adult –
Inpatient/Ambulatory Clinical Practice Guideline for guidance regarding medications that must be
delivered via a central vascular access device.
3.1.3. Good venous access (able to start and maintain the PIV line)
4. Indications for a midline catheter:
4.1. Appropriate midline catheter placement indications:
4.1.1. Expected therapy greater than 5 days and less than 30 days
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

4.1.2. Poor venous access
4.1.3. Infusates appropriate for midline administration (i.e. current or anticipated therapy must not include
medications that require administration via central line based on the Intravenous Administration of
Formulary Medications – Adult – Inpatient/Ambulatory Clinical Practice Guideline)
5. If a midline catheter order is placed and the RN feels a PIV is more appropriate, the RN will communicate the
decision to the ordering provider.
6. If the appropriate venous catheter is not ordered the RN will place an order for a PIV or midline catheter,
whichever is appropriate. A midline order will result in a print out notification in the Vascular Access Team
office. RN will discontinue original line order placed by provider.
7. Bedside RN will notify Vascular Access Team if a midline was ordered but a PIV was determined to be more
appropriate in order to manually take patient off of VAT patient list.
 
Order Mode:  Protocol/Policy – Without Cosign 
 
References:  NA 
 
Collateral Documents/Tools: 
Intravenous Administration of Formulary Medications – Adult – Inpatient/Ambulatory Clinical Practice Guideline 
NEW Policy 1.55A Midline Intravenous Catheter (Adult) 
 
Approved By: 
Nursing Practice Council: October 2015 
Dates of Approval:  October 2015 
 
Scheduled for Review:  October 2015 
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison