How Do We Choose Optimal PIV Sites? Objectives. Good Vein, Bad Vein NIR & Choosing the Best IV Access Site. INS Site Choice Advice Key Points

Size: px
Start display at page:

Download "How Do We Choose Optimal PIV Sites? Objectives. Good Vein, Bad Vein NIR & Choosing the Best IV Access Site. INS Site Choice Advice Key Points"

Transcription

1 Good Vein, Bad Vein NIR & Choosing the Best IV Access Site Greg Schears, MD Mayo Clinic, Rochester, MN Objectives Identify what is known regarding optimal PIV sites in guidelines and the literature Discuss the use of NIR to enhance optimal site choice for PIVs and Phlebotomy Hypothesize how NIR may help prolong PIV dwell time through reduction in complications How Do We Choose Optimal PIV Sites? INS Site Choice Advice Key Points Smallest gauge that will accommodate prescribed therapy Avoid areas of joint flexion, including the hand, all surfaces of the wrist, and the antecubital fossa. Choose insertion sites in the forearm to increase dwell time, decrease complications, promote self care, and prevent accidental removal. INS Policies and Procedures, Section 3 VAD Placement p 52,

2 Extremely Limited Information On Optimal PIV Site Choice! Reality With unaided eye and fingers, we are very limited on vein based critical information We are 20/20 Vein Blind! Because we have almost no idea what s going on inside the vein 2

3 PIV Failure Rates Helm, RE, et al, 2015, JIN 38 (3) If we are going to advance PIV catheter insertion and reduce complications, we must embrace technology and better understand the dynamic relationship of the catheter within the vein particularly its tip position relative to other intravenous structures! PIV Catheter Outcome Factors Site Choice Vein Integrity Catheter Materials Insertion Technique Tip Location Catheter/ Vein Size Catheter Movement Stabilization Infusate / Fluid Jet Other Common Theme in Medicine Selection Determines Outcome 3

4 Ideal Vein for PIV Access Ideal Vein Characteristics Not across joint Adequate size No valves within the area of catheter Adequate supportive No thrombus subcutaneous tissue Good venous flow Healthy vein wall Tip not near Straight pathway tortuosities or bifurcations Method For Identification Veins and Valves 4

5 bum Have You Ever? Blown a vein due to hitting a valve? Caused more pain to a patient from hitting a valve? Second stick? Had the IV pump beep incessantly because the IV catheter tip bumps up against a valve? Have reduced IV flow because the IV catheter tip was up against a valve? 5

6 K Video, Valve 6

7 Easy to Find Valves and Avoid Them Wrist Valve ology Valves are well know to interfere with optimal PIV insertion functionality Difficult to predict where valves will be Rarely can see with the naked eye Very difficult to identify with U/S NIR easily identifies valves by milking vein. Thus NIR necessary for optimal PIV positioning regardless of vein difficulty 7

8 Finding the Straight and Wide 8

9 Picking an Optimal Access Site Must Find Must Avoid Must Avoid Risk of Thrombosis Sharp R, et al. International J Nurs Studies 2015;52: Impact of Catheter Size to Venous Flow TF Nifong, TJ McDevitt, CHEST 2011; 140(1):

10 10

11 Optimal Catheter/Vein Difficult to estimate real vein size for most PIV access using unaided eye. Palpation even more difficult. U/S good but harder to know straightaways and can t easily see valves or tortuosities NIR easily identifies straightaways and projects exact vein width with some products. Thus NIR is necessary for optimal PIV catheter/ vein strategies to preserve flow & integrity. Ideal VA Encounter Provides Pre Access Assessment Pt Hx, Understand Therapy Goals Examine Pt, Consider Options Educate & Partner with the Patient Perform VA Best Practice! Uncomplicated Course Success!!! Everyone s Satisfied 11

12 J Nursing Care Quality, 13 (2), 77 85, 1998 J Nursing Care Quality, 13 (2), 77 85, 1998 PICC Excellence, Nancy Moureau, BSN, CRNI, CPUI, VA BC What must we do to solve this? Need to better define the problem Provide a practical screening tool Work with smart ware developers Help patients to be educated consumers Show how this will improve outcomes Monitor and report patient satisfaction Define financial benefits and compliance with the Affordable Care Act 12

13 INSERTION ATTEMPT Assessment Tool for PIV Access GUIDELINES Grade I Mild Difficulty (Score 6 8) Allow 1 attempt by a nurse/patient care technician with limited IV access experience (supervised by a nurse with IV access experience) or 2 attempts by a nurse/patient care technician with IV access experience, not to exceed 2 attempts total Then contact the Vascular Access Team (VAT) for a maximum of 4 total attempts Grade II Moderate Difficulty (Score 9 12) Contact experienced nurse for a total of 2 attempts Then contact VAT for a maximum of 4 total attempts Grade III Severe Difficulty (Score >12) Contact VAT for a total of 4 attempts (no more than 2 attempts per individual) Purpose: Minimize IV attempts and ensure patient safety and comfort. Available Access Sites 0-1 sites = 3 points 2-3 sites = 2 points > 3 sites = 1 point Patient Age in Years Neonate <1500 grams = 4 points 0-1 = 3 points 1-2 = 2 points > 2 = 1 point Anticipated Duration of IV Access (PICC recommended for treatment > 5 days) > 7 days = 3 points 3-7 days = 2 points < 3 days = 1 point Patient Cooperation Uncooperative/hard to immobilize = 3 points Uncooperative/easy to immobilize = 2 points Cooperative = 1 point Neonate or Poor tolerance to care tasks or extreme agitation with handling = 5 points On narcotic drip for pain or oxygen requirement 30% above patient s previous assessment/baseline = 3 points Desaturations or bradycardia with handling or oxygen 10% above patients previous assessment/baseline = 2 points Parent Cooperation Extreme anxiety (example: request only 1 attempt) = 5 points Expressing concern = 2 points Able to effectively assist or not available = 1 point Patient History Difficult access: previous PICC/CVC = 5 points Poor access (obesity, contracture, congenital anomalies interfering with vascular access) = 4 points Dehydration (dry mucous membranes, decreased UOP, sunken fontanel) = 3 points Prior history of difficult IV access = 2 points No history of IV access problems = 1 point Defining the Problem Defining the Problem No standardized method of screening No standard means of quantifying difficulty of access or limited veins Need to take advantage of modern technology and practices Need scoring system that promotes communication and research Ideal Tool for PVA Easy to apply Makes clinical sense Uses technology available Provides meaningful categorization Allows refined algorithm for line choice Can be validated and is relevant Promotes research and CQI 13

14 Visual Screening Palpation Screening U/S Screening Screening Tool 5 categories for PVA Difficulty 1. V Easily locate accessible veins by sight 2. T Easily locate accessible veins by palpation 3. N Easily locate accessible veins with nearinfrared vein visualization 4. U Accessible veins only identified with ultrasound 5. 0 Lacks adequate veins for peripheral venous access 14

15 Screening Tool cont. Quantification A. > 10 Optimal Choices B Optimal Choices C. 1 5 Optimal Choices Qualifiers A. RF Renal Failure B. CS Chronic Steroids C. SL Site Limitations D. LD Limited Dwell E. P Pediatrics F. G Geriatrics G. Site:B Bilateral, L Left, R Right Pre Assessment Visible, Bilateral, 1 5 veins: V, B, C Palpable, Bilat, 1 5 veins: T, B, C Near Infrared, Bilat, > 10: N, B, A Summary Minimal data on optimal access sites Vision and palpation unable to identify valves & other problems NIR identifies venous obstacles NIR allows for better PIV planning NIR best for finding optimal PIV site Thank You Questions? schears.gregory@mayo.edu 15

NURSING LEADERSHIP IMPACTING CHANGE

NURSING LEADERSHIP IMPACTING CHANGE NURSING LEADERSHIP IMPACTING CHANGE Nancy Moureau, BSN, RN, CRNI, CPUI, VA-BC PICC Excellence, Inc Griffith University Greenville Memorial and University Medical Center, SC Speaker Information Nancy Moureau

More information

Technology Innovations in Vascular Access

Technology Innovations in Vascular Access Technology Innovations in Vascular Access Nancy Moureau, BSN, CRNI PICC Excellence, Inc. nancy@piccexcellence.com Introduction My experience RN for 35 years PICC Instructor and inserter 26 years As a trainer

More information

PICCs. Vascular access is the cornerstone in the. It s all about. Vascular safety:

PICCs. Vascular access is the cornerstone in the. It s all about. Vascular safety: Vascular safety: It s all about PICCs Optimal catheter and vein selection prove vital to patient safety initiatives. By Nancy Moureau, CRNI, BSN Practice challenges Special Vascular access is the cornerstone

More information

Objectives. Vessel Health and Preservation: Disclosure. Ms. Moureau has disclosed the following: Angiodynamics, Genentech

Objectives. Vessel Health and Preservation: Disclosure. Ms. Moureau has disclosed the following: Angiodynamics, Genentech Vessel Health and Preservation: What is the Right Line for the Right Patient at the Right Time? Nancy Moureau, BSN, RN, CRNI, CPUI, VA-BC This program is sponsored by Teleflex Saxe Communications 2012

More information

Request for Contact Hours 2017

Request for Contact Hours 2017 Request for Contact Hours 2017 Demographic Information Educational Event: LITEVAN Annual Educational Meeting, April 20-21, 2017 Title of Event: A Bright Future for Vascular Access Sessions: 12 session

More information

THE JOURNEY TO CLINICAL INDICATION: TIME TO MOVE THE NEEDLE

THE JOURNEY TO CLINICAL INDICATION: TIME TO MOVE THE NEEDLE THE JOURNEY TO CLINICAL INDICATION: TIME TO MOVE THE NEEDLE Michelle DeVries, BS, MPH, CIC Senior Infection Preventionist Methodist Hospitals Gary, IN Michelle DeVries is a paid consultant of Ethicon US,

More information

Pediatric Peripheral IV Access

Pediatric Peripheral IV Access Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Pediatric Peripheral IV Access Kelsey Brault BSN, RN Lehigh Valley Health Network, kelsey_a.brault@lvhn.org Victoria D'Altrui

More information

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE DEPARTMENT OF IV THERAPY (IV THERAPISTS)

SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE DEPARTMENT OF IV THERAPY (IV THERAPISTS) UNIT: SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE DEPARTMENT OF IV THERAPY (IV THERAPISTS) STANDARD #: EFFECTIVE DATE: REVISED DATE: STANDARD TYPE: 04/91 5/05, 3/08 DEPARTMENTAL

More information

Advancing IV Therapy: national update and developments

Advancing IV Therapy: national update and developments Advancing IV Therapy: national update and developments Dr Lisa Dougherty Nurse Consultant IV Therapy 1 2 Aim of Session To provide an overview of how new technologies, techniques and roles have improved

More information

EFFECTIVE OUTCOMES THROUGH IV THERAPY

EFFECTIVE OUTCOMES THROUGH IV THERAPY EFFECTIVE OUTCOMES THROUGH IV THERAPY PROGRAM GUIDE FOR HEALTH CARE PROFESSIONALS National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida

More information

21 st Century Health Care Consultants

21 st Century Health Care Consultants 21 st Century Health Care Consultants Presents 1 Investing in your Infusion Specialty Program Presented by: Rhonda Surgnier RN Becky Tolson RN David Kachel CRNI INFUSION THERAPY OBJECTIVES 2 At the completion

More information

Peripherally Inserted Central Catheter

Peripherally Inserted Central Catheter UW MEDICINE PATIENT EDUCATION Peripherally Inserted Central Catheter Understanding your PICC procedure and consent form Please read this handout before reading and signing the form Special Consent for

More information

LPN 8 Hour Didactic IV Education

LPN 8 Hour Didactic IV Education LPN 8 Hour Didactic IV Education Nurse Practice Act and Regulations By Pamela Truscott, MSN, Nurse Educator, RN Provision of Nursing Care 172 NAC 99 99-003.01B - LPNs contribute to assessment of health

More information

Adopting Best Practice for Infusion Teams

Adopting Best Practice for Infusion Teams Adopting Best Practice for Infusion Teams Lori Mayer, DNP, MSN, RN Shirley O Leary, APN-BC Elida Grienel, APN-BC Infusion Therapies Nursing professionals have increasing responsibility in managing multiple

More information

Recommendations for Improving Safety Practices With Short Peripheral Catheters

Recommendations for Improving Safety Practices With Short Peripheral Catheters INS Position Paper Committee Chair: Cora Vizcarra, MBA, RN, CRNI, VA-BC Carolynn Cassutt, RN, CRNI, CLNC, VA-BC Nancy Corbitt, BSN, RN, OCN, CRNI Deb Richardson, MS, RN, CNS Dana Runde, RN, CRNI Kathy

More information

Evaluating the Use of a Topical Vapocoolant to Reduce Pain during Intravenous Insertions: The Patients' and Nurses' Perspectives

Evaluating the Use of a Topical Vapocoolant to Reduce Pain during Intravenous Insertions: The Patients' and Nurses' Perspectives The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

About your PICC line. Information for patients Weston Park Hospital

About your PICC line. Information for patients Weston Park Hospital About your PICC line Information for patients Weston Park Hospital This booklet explains what a PICC line is, how it is inserted and some general advice on its use and care. What is a PICC line? A Peripherally

More information

The 2016 INFUSION THERAPY STANDARDS. The Infusion Nurses Society (INS) publishes evidence-based practice 1.5

The 2016 INFUSION THERAPY STANDARDS. The Infusion Nurses Society (INS) publishes evidence-based practice 1.5 1.5 HOURS Continuing Education Approximately every 5 years, the Infusion Nurses Society publishes evidence-based practice standards. This article provides an overview of the process used in standards development,

More information

Objectives 31/07/2014. Peripheral IV Catheters: If clinically indicated replacement doesn t work, what will? Financial Disclosures

Objectives 31/07/2014. Peripheral IV Catheters: If clinically indicated replacement doesn t work, what will? Financial Disclosures Peripheral IV Catheters: If clinically indicated replacement doesn t work, what will? Professor Dr Claire Rickard RN PhD Australian Vascular Access Teaching and Research (AVATAR) Group 3M Leadership Summit,

More information

Peripherally inserted central catheter (PICC line) Information to accompany consent

Peripherally inserted central catheter (PICC line) Information to accompany consent Peripherally inserted central catheter (PICC line) Information to accompany consent Exceptional healthcare, personally delivered What is a PICC line? PICC stands for peripherally inserted central venous

More information

Maryland Patient Safety Center s Call for Solutions 2017

Maryland Patient Safety Center s Call for Solutions 2017 Maryland Patient Safety Center s Call for Solutions 7 The Neonatal Intensive Care Unit at The Herman & Walter Samuelson Children s Hospital at Sinai Hospital of Baltimore Drawing Placental Blood for Admission

More information

Intravenous Epoprostenol (Flolan) Therapy

Intravenous Epoprostenol (Flolan) Therapy National Pulmonary Hypertension Service Intravenous Epoprostenol (Flolan) Therapy This information is intended only to be a guide to what you can expect when you start intravenous Flolan treatment. If

More information

Peripheral intravenous catheter performance: investigating peripheral intravenous catheter dwell times

Peripheral intravenous catheter performance: investigating peripheral intravenous catheter dwell times Peripheral intravenous catheter performance: investigating peripheral intravenous catheter dwell times Fourie A, RN, Certificate Wound Care (UOFS) Certificate Wound Management (UK), International Interdisciplinary

More information

Care of Your Peripherally Inserted Central Catheter

Care of Your Peripherally Inserted Central Catheter Care of Your Peripherally Inserted Central Catheter A guide for patients and their carers Acute Oncology Patient Information Leaflet Contents Information for patients: What is a PICC? How is it put in?

More information

Reducing Infection Risks Related to Vascular Access Devices: Competency and Training

Reducing Infection Risks Related to Vascular Access Devices: Competency and Training Reducing Infection Risks Related to Vascular Access Devices: A Focus on Personnel Competency and Training Lynn Hadaway, M.Ed., RN, BC, CRNI Lynn Hadaway Associates, Inc. Milner, Georgia 1 You can submit

More information

201 KAR 20:490. Licensed practical nurse intravenous therapy scope of practice.

201 KAR 20:490. Licensed practical nurse intravenous therapy scope of practice. 201 KAR 20:490. Licensed practical nurse intravenous therapy scope of practice. RELATES TO: KRS 314.011(10)(a), (c) STATUTORY AUTHORITY: KRS 314.011(10)(c), 314.131(1), 314.011(10)(c) NECESSITY, FUNCTION,

More information

F E B R U A R Y 2 8, S C O T T F L A N D E R S, M D V I N E E T C H O P R A, M D

F E B R U A R Y 2 8, S C O T T F L A N D E R S, M D V I N E E T C H O P R A, M D PICC Tier 1 Interventions Webinar F E B R U A R Y 2 8, 2 0 1 7 S C O T T F L A N D E R S, M D V I N E E T C H O P R A, M D Agenda HMS Performance & 2- Tiered Approach (5 minutes) Review PICC Tier 1 Interventions

More information

DEVELOPMENT OF A DIFFICULT VENOUS ACCESS PATHWAY

DEVELOPMENT OF A DIFFICULT VENOUS ACCESS PATHWAY DEVELOPMENT OF A DIFFICULT VENOUS ACCESS PATHWAY Disclosure Research has previously been supported by competitive government, university and unrestricted investigator initiated research/educational grants

More information

BRINGING THE PERIPHERY INTO FOCUS

BRINGING THE PERIPHERY INTO FOCUS BRINGING THE PERIPHERY INTO FOCUS RISKS ASSOCIATED WITH PERIPHERAL IVS Russ Olmsted, MPH, CIC, FAPIC Director, Infection Prevention & Control; Trinity Health, Livonia, MI This educational activity is brought

More information

All About Your Peripherally Inserted Central Catheter (PICC)

All About Your Peripherally Inserted Central Catheter (PICC) All About Your Peripherally Inserted Central Catheter (PICC) General Information Intravenous (IV) therapy is the delivery of fluid directly into a vein. An intravenous catheter is a hollow tube that is

More information

Wyoming STATE BOARD OF NURSING

Wyoming STATE BOARD OF NURSING David D. Freudenthal Governor Wyoming STATE BOARD OF NURSING Mary Kay Goetter, PhD, RNC, NEA-BC Executive Director 1810 Pioneer Avenue Cheyenne, Wyoming 82002 Phone: 307-777-7601 FAX: 307-777-3519 http://nursing.state.wy.us

More information

Organization: Sinai Hospital of Baltimore

Organization: Sinai Hospital of Baltimore Organization: Sinai Hospital of Baltimore Solution Title: Efficacy of using ECG-based technology to confirm tip location when placing a PICC Focus Area: Vascular Access Team (VAT), PICC placement focusing

More information

Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital

Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital MILITARY MEDICINE, 181, 3:272, 2016 Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital LCDR Lauren Oliveira, MC

More information

Arrow Vascular Clinical Education

Arrow Vascular Clinical Education Arrow Vascular Clinical Education Build Skills, Advance Expertise Better Vascular Outcomes Begin Here Your Partner in Excellence Clinical Education Managers Our Clinical Education Managers (CEMs) are readily

More information

Angele Caporicci, RN, CVAA Labour Relations Officer Ontario Nurses Association

Angele Caporicci, RN, CVAA Labour Relations Officer Ontario Nurses Association Angele Caporicci, RN, CVAA Labour Relations Officer Ontario Nurses Association Karen Mallet, RN, CVAA, CON Stem Cell Transplant Nurse North East Cancer Centre, Sudbury Disclosure: no existing conflicts

More information

CQI Project: Cannulation of AVF using Buttonhole technique

CQI Project: Cannulation of AVF using Buttonhole technique CQI Project: Cannulation of AVF using Buttonhole technique CHOW Yuen Ha (APN) Renal Unit Department of Medicine & Geriatrics Princess Margaret Hospital Background Vascular access (VA) is the lifeline of

More information

HHVNA Infusion Therapy MIDLINE CATHETER

HHVNA Infusion Therapy MIDLINE CATHETER CONSIDERATIONS: 1. This midline procedure includes procedural steps for: a. Catheter Insertion b. Flushing c. Site care and dressing change d. Cap change e. Blood Draw f. Management of complications 2.

More information

Vascular Access Planning Guide for Professionals

Vascular Access Planning Guide for Professionals Vascular Access Planning Guide for Professionals www.esrdncc.org Contents Introduction...3 Step 1: Develop Vascular Access Plan...6 Step 2: Refer for Vessel Mapping...8 Step 3: Coordinate the Surgeon Appointment...11

More information

Taking your own blood. Information for patients Infectious Diseases & Tropical Medicine

Taking your own blood. Information for patients Infectious Diseases & Tropical Medicine Taking your own blood Information for patients Infectious Diseases & Tropical Medicine page 2 of 12 We have written this leaflet to give you some important information about taking your own blood sample.

More information

ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access,

ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access, American Journal of Emergency Medicine (2011) 29, 496 501 www.elsevier.com/locate/ajem Original Contribution ED technicians can successfully place ultrasound-guided intravenous catheters in patients with

More information

Gayle Kay Coulter, RN, CRNI, VA-BC

Gayle Kay Coulter, RN, CRNI, VA-BC P.O. Box 8649, Clearwater, FL 33758 Telephone: (727) 446-5825 legal@infusionknowledge.com CURRICULUM VITAE Career History 2001 - Present INFUSION KNOWLEDGE, INC, CLEARWATER, FL Owner / Executive Director

More information

All about Your Implanted Venous Access Device (IVAD, Port )

All about Your Implanted Venous Access Device (IVAD, Port ) All about Your Implanted Venous Access Device (IVAD, Port ) Your doctor has chosen an Implanted Venous Access Device (IVAD) for you based on your treatment needs. Because the IVAD can remain in place for

More information

Having a portacath insertion in the x-ray department

Having a portacath insertion in the x-ray department Having a portacath insertion in the x-ray department This leaflet provides information about a portacath insertion, including the benefits, risks and any alternatives. It also explains what you can expect

More information

Vascular Access Department Insertion of a tunnelled Central Venous Catheter Information for patients

Vascular Access Department Insertion of a tunnelled Central Venous Catheter Information for patients Vascular Access Department Insertion of a tunnelled Central Venous Catheter Information for patients What is a tunnelled central venous catheter (CVC)? A CVC is a long, narrow tube (catheter) that is put

More information

Raising Awareness: Venous Thromboembolism Prevention and Reduction in the Orthopedic Patient Population

Raising Awareness: Venous Thromboembolism Prevention and Reduction in the Orthopedic Patient Population Raising Awareness: Venous Thromboembolism Prevention and Reduction in the Orthopedic Patient Population Unified Quality Improvement Symposium March 31, 2017 Background Venous thromboembolism (VTE) is a

More information

UPMC PASSAVANT Policy Manual. TITLE/SUBJECT: IntraOsseous Device POLICY NO:

UPMC PASSAVANT Policy Manual. TITLE/SUBJECT: IntraOsseous Device POLICY NO: UPMC PASSAVANT Policy Manual TITLE/SUBJECT: IntraOsseous Device POLICY NO: 240.005 DEPARTMENT: Emergency Medicine DATE: April 2015 INDEX TITLE: Dept Specific KEYWORDS: Vascular Access, IO POLICY It is

More information

Hickman line insertion in the interventional radiology department

Hickman line insertion in the interventional radiology department Hickman line insertion in the interventional radiology department This leaflet explains more about what a Hickman line is, how it is inserted into the body and why your doctor has recommended this for

More information

Instructions to use the Training Films in education sessions on health careassociated infections and hand hygiene for health-care workers and

Instructions to use the Training Films in education sessions on health careassociated infections and hand hygiene for health-care workers and Instructions to use the Training Films in education sessions on health careassociated infections and hand hygiene for health-care workers and observers HAND HYGIENE SCENARIOS User instructions (1) The

More information

393 PICC INSERTION USING ULTRASONOGRAPHY AND MICRO INTRODUCER TECHNIQUE 06/10/03 1

393 PICC INSERTION USING ULTRASONOGRAPHY AND MICRO INTRODUCER TECHNIQUE 06/10/03 1 393 ULTRASONOGRAPHY AND MICRO INTRODUCER TECHNIQUE 06/10/03 1 POLICY: General Information: 1. RN s validated to insert PICCs with the additional training in the use of ultrasonography (U/S) and microintroduction

More information

Expanding the Role of a Vascular Access Team:

Expanding the Role of a Vascular Access Team: Expanding the Role of a Vascular Access Team: Incorporating CVCs and Arterial Lines into Your Service Offerings Three Case Studies Introduction As the U.S. healthcare system continues to evolve, an opportunity

More information

WYOMING STATE BOARD OF NURSING ADVISORY OPINION

WYOMING STATE BOARD OF NURSING ADVISORY OPINION WYOMING STATE BOARD OF NURSING ADVISORY OPINION INTRAVENOUS THERAPY BY LICENSED PRACTICAL NURSES Advisory Opinion Number: 03-123 Board Meeting Date: April 28-May 1, 2003 January 7-10, 2008 Introduction:

More information

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: PRESSURE INJURY PREVENTION POLICY EFFECTIVE DATE: REVISED DATE: 126.251(Patient care) 4/18 Job Title of Responsible Owner: Director, Education

More information

1. CRITICAL CARE. Preamble. Adult and Pediatric Critical Care

1. CRITICAL CARE. Preamble. Adult and Pediatric Critical Care 1. CRITICAL CARE Complete understanding of the following paragraphs is essential to appropriate billing of the critical care fees. Members of the team billing the Critical Care Payment Schedule can not

More information

New research: Change peripheral intravenous catheters only as clinically

New research: Change peripheral intravenous catheters only as clinically Content page New research: Change peripheral intravenous catheters only as clinically indicated, not routinely. The results of a nurse led and nationally funded multicentre, randomised equivalence trial

More information

PRACTICAL SKILLS. Objective examination of the patient

PRACTICAL SKILLS. Objective examination of the patient RACTICAL KILL tudent's data. These fields are completed by the student First and last name No of study book In the next tables, total of 76 practical skills are listed by topics that you should develop

More information

CHOC Children s Hospital Best Evidence and Recommendations. Peripherally Inserted Central Venous Catheter (PICC) Optimal Tip Placement & Maintenance

CHOC Children s Hospital Best Evidence and Recommendations. Peripherally Inserted Central Venous Catheter (PICC) Optimal Tip Placement & Maintenance CHOC Children s Hospital Best Evidence and Recommendations Peripherally Inserted Central Venous Catheter (PICC) Optimal Tip Placement & Maintenance Pernilla Fridolfsson BSN, RNC-NIC, VA-BC pfridolfsson@choc.org

More information

The Greater Dayton Area Hospital Association (GDAHA) Nursing Student Experience

The Greater Dayton Area Hospital Association (GDAHA) Nursing Student Experience The Greater Dayton Area Hospital Association (GDAHA) Nursing Student Experience Current Situation: Student nurses have clinical experiences in every hospital within the Dayton and surrounding areas. Each

More information

Misconceptions About Peripheral Intravenous Catheter Complications Rate Based on Insertion Settings: A Comprehensive Literature Review

Misconceptions About Peripheral Intravenous Catheter Complications Rate Based on Insertion Settings: A Comprehensive Literature Review The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey

Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey CE 1.5 HOURS Continuing Education ORIGINAL RESEARCH Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey Study reveals differences in practices and views between certified and

More information

CASE MANAGEMENT POLICY

CASE MANAGEMENT POLICY CASE MANAGEMENT POLICY Subject: Acuity Scale Determination Effective Date: March 21, 1996 Revised: October 25, 2007 Page 1 of 1 PURPOSE: To set a minimum standard across Cooperative agencies regarding

More information

Skin Tunnelled Catheter (STC), also known as Central line

Skin Tunnelled Catheter (STC), also known as Central line Skin Tunnelled Catheter (STC), also known as Central line Intravenous Therapy Department Patient information leaflet What is a skin tunnelled catheter? A skin tunnelled catheter (STC) is a long flexible

More information

Laparoscopic Radical Nephrectomy

Laparoscopic Radical Nephrectomy Urology Department Laparoscopic Radical Nephrectomy Information Aims of this leaflet To give information on the intended benefits and potential risks of kidney surgery To guide you in the decisions you

More information

The peripherally inserted central catheter

The peripherally inserted central catheter AN310305_165-176.qxp 4/15/08 3:31 PM Page 165 Inez Nichols, RN, MSN, CRNI James P. Humphrey, RN, MSN, PhD The Efficacy of Upper Arm Placement of Peripherally Inserted Central Catheters Using Bedside Ultrasound

More information

Making Evidence-based Clinical Decisions. Paul L. Blackburn, BSN, MNA, RN, VA-BC

Making Evidence-based Clinical Decisions. Paul L. Blackburn, BSN, MNA, RN, VA-BC Making Evidence-based Clinical Decisions Paul L. Blackburn, BSN, MNA, RN, VA-BC Disclosures Senior Director of Marketing/Education RyMed Technologies President of the Board of Directors Association for

More information

Peripheral IVs: THINK BIG. LOOK SMALL. Michelle DeVries MPH, CIC. Senior Infection Control Officer Methodist Hospitals Gary, Indiana

Peripheral IVs: THINK BIG. LOOK SMALL. Michelle DeVries MPH, CIC. Senior Infection Control Officer Methodist Hospitals Gary, Indiana Peripheral IVs: THINK BIG. LOOK SMALL. Michelle DeVries MPH, CIC Senior Infection Control Officer Methodist Hospitals Gary, Indiana Michelle DeVries is a paid consultant of Ethicon US, LLC. This promotional

More information

Peripherally Inserted Central Catheter (PICC)

Peripherally Inserted Central Catheter (PICC) University Teaching Trust Peripherally Inserted Central Catheter (PICC) IV Team 0161 206 0459 All Rights Reserved 2017. Document for issue as handout. Contents l What is a PICC? l Why do I need a PICC?

More information

WYOMING STATE BOARD OF NURSING ADVISORY OPINION INTRAVENOUS THERAPY BY LICENSED PRACTICAL NURSES

WYOMING STATE BOARD OF NURSING ADVISORY OPINION INTRAVENOUS THERAPY BY LICENSED PRACTICAL NURSES WYOMING STATE BOARD OF NURSING ADVISORY OPINION INTRAVENOUS THERAPY BY LICENSED PRACTICAL NURSES Advisory Opinion Number: 03-123 Board Meeting Date: April 28-May 1, 2003 January 7-10, 2008 February 18,

More information

If viewing a printed copy of this policy, please note it could be expired. Got to to view current policies.

If viewing a printed copy of this policy, please note it could be expired. Got to  to view current policies. If viewing a printed copy of this policy, please note it could be expired. Got to www.fairview.org/fhipolicies to view current policies. Department Policy Entity: Fairview Pharmacy Services Department:

More information

Running head: NURSING RESEARCH AND EVIDENCE BASED NURSING PRACTCE 1

Running head: NURSING RESEARCH AND EVIDENCE BASED NURSING PRACTCE 1 Running head: NURSING RESEARCH AND EVIDENCE BASED NURSING PRACTCE 1 EVIDENCE BASED NURSING AND PERSONAL PRACTICE Sofia L. Warren Ferris State University NURSING RESEARCH AND EVIDENCE BASED NURSING PRACTCE

More information

Peripherally Inserted Central Catheter (PICC)

Peripherally Inserted Central Catheter (PICC) Peripherally Inserted Central Catheter (PICC) Intravenous Therapy Patient information leaflet What is a PICC? A PICC is a very fine flexible tube measuring 50 60 cm in length. It is placed in a vein in

More information

Heart Rhythm Program, St. Paul s Hospital Lead Extraction

Heart Rhythm Program, St. Paul s Hospital Lead Extraction Heart Rhythm Program, St. Paul s Hospital Lead Extraction FD.723.P114.PHC (R.Feb-18) What is a lead? A cardiac lead is a special wire that sends energy from a pacemaker or implantable cardioverter defibrillator

More information

Adopting Standardized Definitions The Future of Data Collection and Benchmarking in Alternate Site Infusion Must Start Now!

Adopting Standardized Definitions The Future of Data Collection and Benchmarking in Alternate Site Infusion Must Start Now! Adopting Standardized Definitions The Future of Data Collection and Benchmarking in Alternate Site Infusion Must Start Now! Connie Sullivan, RPh Infusion Director, Heartland IV Care Lyons, CO CE Credit

More information

You and your Totally Implanted Vascular Access Device (TIVAD) - Portacath

You and your Totally Implanted Vascular Access Device (TIVAD) - Portacath You and your Totally Implanted Vascular Access Device (TIVAD) - Portacath Nursing A guide for patients and carers Contents What is a TIVAD?... 1 Why is a TIVAD necessary?... 2 How a TIVAD is inserted...

More information

Central Venous Access Devices (CVADs)

Central Venous Access Devices (CVADs) Contents Purpose... 1 Policy... 1 Scope... 2 Associated documents... 2 1 Insertion of CVADs... 2 2 Endorsement/Certification... 2 3 Procedural Considerations... 3 3.1 Checking and Identification requirements...

More information

Informed Disclosure & Consent for Care/Homebirth River & Mountain Midwives PLLC Susan Rannestad & Susanrachel Condon

Informed Disclosure & Consent for Care/Homebirth River & Mountain Midwives PLLC Susan Rannestad & Susanrachel Condon Informed Disclosure & Consent for Care/Homebirth River & Mountain Midwives PLLC Susan Rannestad & Susanrachel Condon Please write in your own handwriting. Mother s name print your address, including zip

More information

Functional Abilities / Core Performance Standards

Functional Abilities / Core Performance Standards Functional Abilities / Core Performance Standards Please Review the list of skills below. If you unable to meet the standard/s even with correction (example: eyeglasses, hearing aids) on any of the items

More information

N: Emergency Nursing. Alberta Licensed Practical Nurses Competency Profile 135

N: Emergency Nursing. Alberta Licensed Practical Nurses Competency Profile 135 N: Emergency Nursing Alberta Licensed Practical Nurses Competency Profile 135 Competency: N-1 Multi-Systems Assessment N-1-1 N-1-2 N-1-3 N-1-4 Demonstrate knowledge and ability to apply critical thinking

More information

PROTOCOL FOR VENESECTION

PROTOCOL FOR VENESECTION PROTOCOL FOR VENESECTION Author: Scope: Date: Dr John de Vos All staff who carry out venesection June 2015 (original June 2006 Dr Janet Shirley) Ratified by: Clinical Audit and Effectiveness Committee

More information

PICC line trends and cost effectiveness

PICC line trends and cost effectiveness PICC line trends and cost effectiveness Poster No.: C-0656 Congress: ECR 2015 Type: Educational Exhibit Authors: C. O Brien, P. Govender, W. Torregiani, O. Doody; Dublin/IE Keywords: Epidemiology, Audit

More information

IMPLEMENTATION OF A DIFFICULT VENOUS ACCESS (DiVa) PATHWAY

IMPLEMENTATION OF A DIFFICULT VENOUS ACCESS (DiVa) PATHWAY IMPLEMENTATION OF A DIFFICULT VENOUS ACCESS (DiVa) PATHWAY Evan Alexandrou RN MPH PhD Clinical Nurse Consultant, Central Venous Access Service Liverpool Hospital Senior Lecturer Western Sydney University

More information

M-fhUb~a.2. ~ Feidhmeannacht na Seirbhise Siainte Hea1Ul Service Executive

M-fhUb~a.2. ~ Feidhmeannacht na Seirbhise Siainte Hea1Ul Service Executive Feidhmeannacht na Seirbhise Siainte Hea1Ul Service Executive TITLE: Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH),, Regional Orthopaedic Hospital, Croom and Regional

More information

Improving Patient Surveillance: Instituting a Respiratory Risk Screening Tool

Improving Patient Surveillance: Instituting a Respiratory Risk Screening Tool Improving Patient Surveillance: Instituting a Respiratory Risk Screening Tool Sandra Maddux, RN, MSN, CNS-BC, Michelle Giffin, RN, BSN, & Patti Leglar, RN-C, BSN Purpose To share an evidence-based protocol

More information

Alaris Products. Protecting patients at the point of care

Alaris Products. Protecting patients at the point of care Alaris Products Protecting patients at the point of care Overview The medication process is the largest source of medical errors 1 with medication errors costing an estimated $3.5 billion yearly in hospitals.

More information

Totally Implantable Venous Access Devices (port) Information for patients. Cross section of a port

Totally Implantable Venous Access Devices (port) Information for patients. Cross section of a port Cystic Fibrosis Unit, Ward 26 0121 424 2000 Information for Patients Totally Implantable Venous Access Devices (port) Information for patients This leaflet tells you about the procedures for Totally Implantable

More information

Limitations and Guidelines Revised for Elastomeric Devices and IV Supplies and Equipment

Limitations and Guidelines Revised for Elastomeric Devices and IV Supplies and Equipment Limitations and Guidelines Revised for Elastomeric Devices and IV Supplies and Equipment Information posted January 8, 2007 Effective for dates of service on or after March 1, 2007, benefit limitations

More information

Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians B

Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians B American Journal of Emergency Medicine (2009) 27, 135 140 www.elsevier.com/locate/ajem Original Contribution Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians

More information

Routine vs. Clinically Indicated Peripherally Inserted Intravenous Catheter Changes

Routine vs. Clinically Indicated Peripherally Inserted Intravenous Catheter Changes Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Routine vs. Clinically Indicated Peripherally Inserted Intravenous Catheter Changes Juliet Hahn BSN, RN Lehigh Valley Health

More information

1. Communicate to the UAP any special information needed prior to the administration of the medication.

1. Communicate to the UAP any special information needed prior to the administration of the medication. Objectives At the completion of this module, unlicensed assistive personnel (UAP) should be able to: 1. administer medications by intradermal injection. 2. document medication administration in the client

More information

CE Code (Attendee Use Only):

CE Code (Attendee Use Only): Evan Alexandrou RN MPH PhD Senior Lecturer School of Nursing and Midwifery University of Western Sydney, Australia Clinical Nurse Consultant in Central Venous Access & Parenteral Nutrition - Liverpool

More information

Institutional Handbook of Operating Procedures Policy

Institutional Handbook of Operating Procedures Policy Section: Admission, Discharge, and Transfer Institutional Handbook of Operating Procedures Policy 9.1.29 Responsible Vice President: EVP & CEO Health System Subject: Admission, Discharge, and Transfer

More information

STANDARDIZED PROCEDURE CENTRAL LINE PLACEMENT and TEMPORARY NONTUNNELLED CENTRAL VENOUS DIALYSIS CATHETER INSERTION (Adult, Peds)

STANDARDIZED PROCEDURE CENTRAL LINE PLACEMENT and TEMPORARY NONTUNNELLED CENTRAL VENOUS DIALYSIS CATHETER INSERTION (Adult, Peds) I. Definition: This protocol covers the task of central (venous) catheter placement and temporary nontunnelled central venous dialysis catheters by the Advanced Health Practitioner. The purpose of this

More information

AMERICAN JOURNAL OF ADVANCES IN NURSING RESEARCH

AMERICAN JOURNAL OF ADVANCES IN NURSING RESEARCH 49 AMERICAN JOURNAL OF ADVANCES IN NURSING RESEARCH e - ISSN 2349-0691 Print ISSN - XXXX-XXXX Journal homepage: www.mcmed.us/journal/ajanr INTRA VENOUS (IV) SAFETY NURSE: FROM ROUTINE PRACTICE TO SAFE

More information

Midline Catheter Use in the Newborn Intensive Care Unit

Midline Catheter Use in the Newborn Intensive Care Unit UNF Digital Commons UNF Theses and Dissertations Student Scholarship 2014 Midline Catheter Use in the Newborn Intensive Care Unit Tricia L. Romesberg University of North Florida Suggested Citation Romesberg,

More information

SARASOTA MEMORIAL HOSPITAL

SARASOTA MEMORIAL HOSPITAL SARASOTA MEMORIAL HOSPITAL TITLE: ISSUED FOR: NURSING PROCEDURE INTRAPERITONEAL (IP) PORT USE FOR Nursing DATE: REVIEWED: PAGES: 02/86 6/18 1 of 9 PS1094 RESPONSIBILITY: Chemotherapy RN who is also competent

More information

IV 03 CRAIG HOSPITAL POLICY/PROCEDURE

IV 03 CRAIG HOSPITAL POLICY/PROCEDURE CRAIG HOSPITAL POLICY/PROCEDURE Approved: NPC, P&P 12/06; P&T 2/07; Effective Date: 10/78 IC, MEC 03/07; NPC, P&P 08/09; MEC 9/09 P&T 12/10; MEC, P&P 01/11, 04/11; NPC, P&P 06/12, 06/15, 12/15 ; NPC, P&T,

More information

UW MEDICINE PATIENT EDUCATION. Angiography: Percutaneous or Transjugular Liver Biopsy. How to prepare and what to expect. What is a liver biopsy?

UW MEDICINE PATIENT EDUCATION. Angiography: Percutaneous or Transjugular Liver Biopsy. How to prepare and what to expect. What is a liver biopsy? UW MEDICINE PATIENT EDUCATION Angiography: Percutaneous or Transjugular Liver Biopsy How to prepare and what to expect This handout explains how to prepare and what to expect when having a percutaneous

More information

Changing behaviors through education to improve patient outcomes associated with vascular access devices

Changing behaviors through education to improve patient outcomes associated with vascular access devices Changing behaviors through education to improve patient outcomes associated with vascular access devices Fiona Fullerton Clinical Nurse Consultant Vascular Access Surveillance Princess Alexandra Hospital,

More information

Medical technologies guidance Published: 5 June 2017 nice.org.uk/guidance/mtg34

Medical technologies guidance Published: 5 June 2017 nice.org.uk/guidance/mtg34 for securing percutaneous catheters Medical technologies guidance Published: 5 June 2017 nice.org.uk/guidance/mtg34 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

Transition to District Nursing Service

Transition to District Nursing Service Transition to District Nursing Service Contents Section A - Thinking about working in the community Chapter 1 - What is community nursing Chapter 2 - Making the transition Section B - Working in the community

More information

ABOUT REVEAL LINQ DURING

ABOUT REVEAL LINQ DURING TALKING ABOUT REVEAL LINQ DURING CONSULT INTRODUCE THE SYSTEM o Help patients understand how the components work together Two primary components: Reveal LINQ ICM a small device that is inserted just under

More information