IV Insertion and Management

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2 Purpose The purpose of this e-learning module is to educate the healthcare team on IV insertion and management This module is not intended to be all inclusive, but rather provides an overview of salient points related to IV insertion and management. 2

3 Who may start an IV? Peripheral intravenous (PIV) catheters may be inserted by health care providers whose competency has been validated. RN MD NP PA LPN 3

4 Policy Peripheral IV (PIV) catheters should be changed to a new site every 96 hours. The site must be assessed as per protocol Frequency of monitoring a peripheral intravenous site is determined by the prescribed therapy (i.e. chemo, blood, TPN, medications), the condition and age of the patient and the practice setting 4

5 Extenuating Circumstances All PIV catheters must be removed after 5 days however When it is in the best interest of the patient to extend past 96 hours, the insertion site will be assessed and a prescriber order will be required. 5

6 Do you need to change the IV site? Any PIV inserted at another location may be retained if it is within the acceptable time frame and the site and equipment are appropriate. 6

7 Policy All IV locks are flushed every shift. All IVs are started with an medlock extension set attached to the catheter. Medlock Extension set 7

8 Site Selection Carefully examine both arms for most appropriate vessels Most commonly used veins for placement of IV catheters are: Metacarpal Cephalic Basilic 8

9 Lower Extremity PIV insertion in a lower extremity: requires a valid order should utilize the smallest gauge catheter appropriate for the therapy ordered requires the patient be on bed rest should be changed to an upper extremity or to a central line as soon as possible 9

10 Things to Consider Location of vein Condition of vein Purpose and type of infusion Duration of therapy Catheter material Catheter size needed to delivery therapy Patient s age, diagnosis, prior surgeries, procedures Patient activity Patient preference 10

11 Avoid Do not use veins in affected arm of patients with: history of mastectomy hemodialysis shunt or fistula axillary dissection or biopsy surgical procedures Limb restriction band 11

12 Avoid Joint regions Sclerotic veins Site near recent complication Site under restraints; Inner wrist Locations with impaired circulation Legs and feet 12

13 Getting Started 13

14 Ensure a valid written order Date 9/3/10 Time 1230 Order IV Lock Signature Bob Cohen,MD Contact # Beeper

15 Wash Hands Standard infection control practices require the use of aseptic technique. 15

16 Identify Patient Check identification band. In (outpatient) services where ID bands are not utilized, identification is confirmed by passport, SSN, verbal confirmation, patient / significant other. 16

17 Check for Allergies Check the allergy band. Ask patient if he/she has any known reactions to ChloraPrep or anything else. 17

18 Explain Procedure to Patient Tell the patient what you are going to do 18

19 Equipment IV start kit Angiocatheter CLAVE Extension Set Saline IV flush 19

20 Prime CLAVE Extension Set Flush extension set with normal saline. Clave must be cleansed with alcohol after initial flush whenever IV lock is accessed 20

21 CLAVE (bigger picture) Never use needles or blunts 21

22 Peripheral IV Start Kit contents: Drape Tourniquet Gloves ChloraPrep 2X2 gauze Hubguard Alcohol prep Dressing Label Tape 22

23 Open the IV Start Kit 23

24 Place Drape Under Extremity 24

25 IV Angiocatheter Open your angiocatheter 25

26 e-module Angiocatheter Gauge Selection Key points to consider: Type of intravenous solution or medication Type of procedure or surgery to be performed Patient s diagnosis History of IV therapy Patient s activity level Patient s age Venous status 26

27 e-module Size Does Matter Select the device with the shortest length and the smallest diameter that allows for proper administration of the prescribed therapy. Note: The smaller the gauge number, the bigger the diameter. Example: 18 gauge is bigger than 24 gauge. 27

28 e-module 16 Gauge and Larger Uses: High-risk surgical procedures 18 Gauge Uses: Surgery Large fluid and blood volumes Improved flow rate for viscous solutions and blood transfusions Rapid infusions Rapid infusions 28

29 e-module 20 Gauge Uses: Most routine infusions Minor surgical procedures Routine outpatient procedures requiring IV access Appropriate for blood components, when rapid rates are not required 22 Gauge Uses: Most routine infusions Delivery of antibiotics Hydration therapy at slower rates Small or fragile veins 29

30 IV INSERTION VIDEO Click below to watch a 4 minute video of IV insertion technique using the angiocatheter utilized at NSLIJHS. 30

31 e-module Upon completion, place angiocatheter in Sharps Container Angiocatheter needle should be retracted prior to disposal in the sharps container (by pressing the white button as demonstrated in the video). Remove gloves Place all other used equipment in regular garbage. 31

32 e-module Wash your hands Provide patient education Activity restrictions Notify nurse if any pain, swelling, burning, redness or discomfort at site, or if any blood in IV lock or tubing Avoid any pressure to IV site 32

33 e-module Document on Progress Note Location of IV site Size of catheter Date and time of insertion Patient teaching Patient tolerance to procedure. 33

34 e-module An Untoward Event.. Provide appropriate intervention infiltration Document in progress notes Include description of event multiple attempts hematoma infiltration Vessicant infiltration. hematoma 34

35 e-module Adding IV solution to your newly inserted IVLock 35

36 e-module Peripheral IV (PIV) tubing policy PIV tubing is changed every 96 hours Exceptions: With every unit or every 4 hours for blood administration every 24 hours for TPN Lipid based medications every 12 hours Peripheral IV (PIV) fluid policy PIV fluid bag is changed every 24 hours. 36

37 e-module Intermittent Piggyback Policy If a secondary line is used intermittently (not through a running main line) and connected directly to a IV lock, that tubing must be changed every 24 hours. Any tubing that is not capped after use is considered contaminated and must be discarded immediately. 37

38 e-module IV site assessement policy PIV site should be reassessed every 2 hours and documented on the patient care record. 38

39 e-module Attaching an IV infusion IV fluid bag (per order) IV tubing Tubing and bag labels 39

40 e-module Setting the Drip (Infusion) Rate All pumps in the NSLIJHS have the capacity to calculate infusion rates. In the event of failure, you will need to able to calculate an infusion rate Drip rate formula: (Amount in ml) X (tubing drop factor) Time for delivery in minutes (100mls to deliver) x (drop factor of 10) 60 min = # of gtts/min = 16.6 or 17gtts/min 40

41 e-module IV Solution Start IV solution and adjust flow rate. Protect against accidental dumping of IV fluids (leaving the roll clamp open and allowing rapid infusion of fluid, inadvertently). 41

42 e-module Labeling Write date on IV tubing using a sticker Write date and time on IV solution using a sticker. Include type and amount of solution hung, time started and flow rate 42

43 e-module You have completed this module Competency validation will occur through return demonstration of an IV insertion. 43