Department: INFUSION THERAPY
PROVIDING APPROPRIATE care for patients with venous access devices is a vital nursing competency. Nurses can use the acronym KISSSS to remember some important peripheral I.V. catheter skills they need: Know to Inspect the Site, Stabilize and Secure it, and Stop (or remove) as needed.
To prevent I.V.-related complications, I.V. sites must be assessed at least daily and whenever the site is accessed. Ongoing nursing responsibilities include monitoring the I.V. site for signs and symptoms of infection and other complications. This article discusses how using the memorable KISSSS acronym can help nurses perform essential I.V. skills that promote patient safety.
A need for consistency
A recent study revealed a lack of policy consistency across facilities regarding I.V. site care.1 The CDC guidelines and the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice guide policies and procedures in current nursing practice. To aid nurses in proper care of peripheral I.V. catheters, we developed the KISSSS acronym.
Know to Inspect the Site
Site inspection should occur at least daily or more often as needed, and each time an I.V. catheter is accessed. The INS Infusion Therapy Standards of Practice state an assessment should be done every 1 to 2 hours for the critically ill and sedated; hourly for neonatal and pediatric patients; and more frequently for patients receiving vesicant medications. For other patients with a peripheral I.V. catheter, inspection should be performed at least every 4 hours.
Be sure to perform hand hygiene before and after accessing any venous access device and don gloves. Assess the I.V. catheter to verify proper placement and patency and assess the site for the presence of erythema, edema, pain, tenderness, or other abnormalities.2
Stabilize and Secure it
Apply sterile tape and/or a stabilizing device with the correct technique when anchoring the I.V. catheter to the skin.3-5 Follow manufacturer instructions. The aim of stabilization is to prevent catheter dislodgement and minimize catheter movement, which may contribute to mechanical causes of phlebitis. Effectively securing the I.V. device also prevents discomfort.3-5
Stop (or remove) as needed
The length of time a short peripheral I.V. catheter can remain in place is based on the policies and procedures of each healthcare facility, as well as on evidence-based guidelines. All catheters should be removed as soon as they're no longer needed.2 Note and record the I.V. catheter insertion date, and check facility policy for replacement or rotation schedules. Catheters shouldn't be replaced more frequently than every 72-96 hours unless complications occur. If the patient shows signs of infection, a malfunctioning catheter, or phlebitis, which includes warmth, tenderness, erythema, or a palpable venous cord, remove the catheter and insert a new catheter in a new site if venous access is still needed.2
A framework for safety
Skilled I.V. assessment and proper monitoring and care of peripheral venous catheters, following facility policy, are essential in preventing I.V. catheter-related complications, including infection.
1. Helton J, Hines A, Best J. Peripheral IV site rotation based on clinical assessment vs. length of time since insertion. Medsurg Nurs
3. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs
4. Alekseyev S, Byrne M, Carpenter A, Franker C, Kidd C, Hulton L. Prolonging the life of a patient's IV: an integrative review of intravenous securement devices. Medsurg Nurs
5. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs
. 2016;39(suppl 1):S1–S145.