Controversial issues in the care and maintenance of vascular access devices in the long-term/subacute care client

The aging population provides a unique challenge for the initiation and maintenance of infusion therapy. This article will highlight three common but controversial issues that have been observed by this author in the long-term/subacute care realm of infusion therapy: 1) the failure to maintain a sterile dressing over the catheter insertion site; 2) the use of heparin to maintain patency of the peripheral infusion device; and 3) the routine replacement of peripheral i.v. catheters. Several factors that contribute to the controversies will be discussed, along with some associated negative and positive outcomes.