Patient Instructions: Peripheral Intravenous Catheter (PIV)

Patient Instructions: Peripheral Intravenous Catheter (PIV)

These instructions are for Children’s Hospital of Philadelphia (CHOP) patients with a peripheral intravenous catheter (PIV).

Important information:

  • A PIV is inserted when your child needs intravenous (IV) fluids or IV medicines that cannot be given by mouth or feeding tube. 
  • It is a short tube that is inserted through the skin into a vein. A small needle is used to insert this catheter. The needle is removed, and the catheter stays in the vein. A PIV can be placed in the arm, hand, leg, foot and sometimes in the scalp. 
  • There may be some discomfort as the needle and catheter are inserted. We try to keep your child as comfortable as possible during the placement. We can provide options for increasing comfort for your child such as positioning, distraction, guided imagery and medicines, depending on your child’s age and medical condition. Child Life Specialists may be available to help your child cope with PIV placement. 
  • A dressing is placed over the PIV when it is inserted. The dressing needs to be changed by a nurse if it is wet, soiled or bloody. It will also be changed if it becomes loose or begins to fall off. 
  • Hourly PIV site checks:
    • For safety reasons, we will be looking at the PIV every hour while fluids are going through it, even when your child is asleep. The nurse will need to check the PIV and dressing by turning on a light and comparing both arms or legs. We may need to reposition your child and remove pajamas or anything blocking the PIV site. This allows us to have a full view of the extremity that the PIV is in. 
    • We check the site to keep your child safe from an IV infiltrate. An infiltrate is when IV fluid or medicine flow under the skin, rather than into the vein. This can irritate your child’s skin. You can help partner with us to prevent infiltrates. Let us know if you see any redness, leaking or swelling. Also tell us if your child seems irritable or if he has any discomfort at his PIV site.

Instructions for bathing:

  • Your child may shower or bathe with the dressing in place, but we need to protect the dressing. The clear dressing is water-resistant, but not waterproof.
  • While you are in the hospital, your child’s nurse can help you place the PIV site and tubing ends in a plastic bag and tape it to the body. You can follow the same steps for bathing at home.
  • If your child is taking a bath, keep the dressing above the bath water.
  • If your child is showering, they should face away from the spray, protecting the PIV site. The water should hit your child’s back, not the PIV site directly.

Instructions for the PIV dressing at home:

The PIV dressing needs to be changed if it:

  1. Looks wet underneath.
  2. Becomes loose or begins to fall off.
  3. Is soiled or bloody.

If any of these happen to your child’s PIV at home, follow these steps:

  1. Clean your hands with soap and water or hand sanitizer.
  2. Put a dry gauze pad over the dressing, and tape it down to keep the dressing from falling off.
  3. Call your home care company to arrange for a nurse to come and change the dressing.

Instructions for flushing the PIV at home:

Blood can back up in the PIV and cause the catheter to clot.  

  • If your child is not getting medicine or fluid, you will flush the catheter with saline every eight hours. We will teach you how to do this. Keep the clamp closed on the small tubing that is attached to the PIV.
  • If your child is getting medicines or fluid through the PIV, you will flush the catheter with saline before giving the medicine or starting fluids. This will show you if the PIV is working properly. After the medicine goes in or the fluids are done, you will flush with saline again. If your child needs PIV medicines or fluids at home, we will give you more detailed instructions.
  • Follow these steps for flushing the PIV:
    1. Gather supplies:
      • Alcohol pad
      • Saline flush syringe
    2. Clean hands with soap and water or hand sanitizer.
    3. Remove the air from the flush syringe:
      • Gently tap the side of the syringe to make any air bubbles rise to the top.
      • Remove the cap from the syringe and hold it, making sure that nothing touches the inside of the cap or the end of the syringe.
      • Place the syringe in your hand and gently push up on the plunger with your thumb. You may feel resistance, and then the plunger will move.
      • Continue to push up until a small amount of saline solution comes out of the top of the syringe.
    4. Replace the cap on the syringe until you are ready to use it.  
    5. Scrub the catheter cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.
    6. Remove the cap from the syringe and screw the end of the syringe onto the PIV cap.
    7. Twist to the right until it is securely connected.
    8. Unclamp the PIV.
    9. Using push-pause technique, push the saline from the syringe into the PIV and then clamp the PIV.
    10. If the PIV is hard to flush, stop pushing in the saline. Check to make sure the PIV is not clamped and that there are no kinks in the tubing.
    11. If you are still having trouble flushing, clamp the line, remove the flush syringe and call your home care company.
    12. Unscrew the syringe from the PIV cap and throw it away. Check to make sure the PIV cap is still on tightly.  
    13. The PIV does not have to be changed on a regular schedule. Call your home care nurse to change it if:
      • It looks red or swollen.
      • Your child complains of pain at site.
      • It won’t flush.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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