Peripheral Intravenous Line (PIV): Care at Home

Article Translations: (Spanish) (Somali)

What is a PIV?

A peripheral intravenous line (PIV) is a catheter (a very thin, flexible tube) that is inserted into a small vein in the arm, hand, leg, or foot. This is done to give fluids or medicines directly into the bloodstream. 

How should I care for my child?

As your child improves and is able to be at home, nurses will teach and help you become comfortable with the PIV and how to care for it before you do them yourself. The hospital staff will lead and supervise line cares any time your child is in the hospital. 

These are the things you will need to learn before going home:

• preventing infection
• checking the PIV site
• giving medicine
• flushing
• knowing when and who to call for help

Preventing infection

It is very important to prevent infection, or the PIV may need to be removed. There are things you can do to prevent a PIV infection.

Cleanliness is a must!

1. Clean your hands with alcohol-based sanitizer or wash with soap and water before caring for your child's IV. This means washing your hands before:
   • Flushing the PIV, giving medicines, and any time handling the IV.
2. Clean solid surface work areas with a disinfectant (such as Lysol® or another brand) when preparing to do PIV cares. 
3. Before each time you flush or put any medicine into the PIV tubing, scrub the injection cap for 15 seconds with a fresh chlorhexidine (CHG) wipe, using friction. Allow to dry for 15 seconds and until completely dry. Do not fan or blow on it.

Checking the PIV site

Before giving any medicine, always check the PIV site to make sure there are no problems. Check for:

• redness
• swelling
• leaking
• pain
• tenderness

If any of the above are present, do not give the medicine. Never force medicines into the PIV. If your child cries or says it hurts when the medicine is pushed in, call the home care nurse for help in problem solving. (See chart below).

Sometimes a PIV may need to be restarted. Your child's doctor and home care nurse will talk with you about a plan for this if needed.

Giving medicine and flushing the PIV

Depending on your child's needs, you will follow one of these steps:

___ Flush with normal saline.

___ Flush with normal saline, give medicine, flush again with normal saline.

Adjust the following steps to fit your needs checked above.

1. Clean and prepare the work surface.
2. Clean your hands well.
3. Gather supplies:
   
   • Chlorhexidine gluconate (CHG) wipes
   • normal saline syringe (2 if giving medicine)
   • medicine (if ordered), and supplies to give it
   • Heparin flush
4. Check the labels of the normal saline and syringes and any other medicines or fluids before giving them. Make sure they are the right medicines and the right dose.
   
   • A medicine is good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness.
   • If you don't have pre-filled syringes, draw up the correct amounts into separate syringes. (See education sheet "IV medicines: Preparing at home.")
5. Prepare pre-filled normal saline syringe(s) by removing the air bubble in them. Remove cap. Hold syringe tip up. Pull back slightly on the plunger and then push plunger gently squirting the air bubble out. Place cap back on the syringe.
6. Scrub the injection cap with a CHG wipe for 15 seconds and let it dry for 15 seconds and until completely dry.
7. Attach the normal saline syringe tip into the injection cap.
8. Unclamp the catheter and slowly inject the normal saline into the PIV catheter.
9. When the syringe is empty, remove it from the injection cap.
10. If you are not giving medicine through the PIV, go to step 17.
11. Scrub the injection cap with a CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
12. Connect and give the medicine as instructed by your home care nurse.
13. After the medicine is given, disconnect it from the PIV catheter.
14. Scrub the injection cap with a CHG wipe for 30 seconds and allow to dry for 30 seconds until completely dry.
15. Attach the normal saline syringe tip into the injection cap and slowly inject the normal saline in to the PIV catheter.
16. When the syringe is empty, remove it from the injection cap.
17. Attach heparin syringe tip into the injection cap and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
18. Clamp the PIV catheter.
19. Put used syringes and supplies into your regular trash. For syringes with blood, use a special container, such as a hard-plastic bottle with a screw-on lid. Label it "Do Not Recycle - Household Sharps."
    • Do not overfill the sharps container. Disposal varies depending on the area you live in. Some communities have a household sharps collection program. To find out what you should do, check with your garbage collection company, pharmacy, or clinic.

Where do I order supplies?

Your supplies will be ordered from a medical equipment supply company or home care pharmacy. The first order will be delivered to the hospital or your home. Check with your nurse to be sure you have everything you need. You will receive the number to call when you need to order supplies in the future.

Who and when should I call for help?

Call the home care nurse if your child has:

• fever and/or chills
• problems with the IV, such as redness, tenderness, or swelling
• questions about treatments, medicines, or supplies

Questions?

If you have any questions, please call your home care nurse.

Problem solving

Problem	Possible cause	What to do
Infusion will not start or infuses slowly	Clamp closed	Open all clamps.
	Kink or bend in tubing	Check all tubing. Change hand or arm position.
	Tape too tight over site	Loosen any tape over IV site.
	IV plugged or out of the vein	Flush IV gently with normal saline. If IV is painful, hard to flush, or continues to infuse slowly, clamp the IV and call the home care nurse.
IV site is sore, painful, reddened, swollen, or draining	IV out of vein Irritation of the vein Infection at site	Do not give medicine or begin infusion. Call home care nurse.
Leaking fluid at injection site or at tubing connections	Loose connections IV out of vein	Tighten all connections. Change injection cap. If leaking continues, stop the infusion and call the home care nurse.
Infusion painful to child	IV out of vein Irritation of the vein	Check IV site for redness or swelling (as above). Flush IV gently with normal saline. If IV flushes easily, restart infusion and observe child. If IV is hard to flush or child is uncomfortable, call the home care nurse.
	Medicine too concentrated for child	Call the home care nurse to discuss; it may be possible to dilute the medicine.
Fluid bag leaks	Defective bag Hole in bag from spike of IV tubing	Discard leaking bag and replace with a new one. Call home care nurse or pharmacy to let them know that the bag was discarded.
Dressing (bandage) becomes loose or soiled	Leaking IV fluid Bathing Accidental pull	Change dressing if you have been taught how. Put tape over existing dressing or reinforce edges with tape to secure IV until it can be re-taped. Use stockinette and/or armboard as directed. Call home care nurse for more suggestions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Reviewed 4/2023 by Vascular Access and Home Care

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