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IV Insertion and Management
e-Module IV Insertion and Management
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.
e-Module IV Insertion and Management
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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 * Check site and local policy
e-Module IV Insertion and Management
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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
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Extenuating Circumstances
All PIV catheters should be changed to a new site every 96 hours (4 days) or as needed
• Nursing assessment of patient’s available peripheral venous
access and/or the condition of IV site determines if PIV
should stay in place longer than 96 hours (4 days).
• Extenuating circumstances necessitating extending the above
time frame will require notifying the physician of the need to
extend the time frame due to venous access and obtaining an
order for a maximum of an additional 24 hours for a total of
120 hours (5 days).
e-Module IV Insertion and Management
Peripheral IV that was inserted at
another location may be retained if:
– IV is inserted within 96 hours
– The site is without complications (of pain, redness,
swelling, drainage).
– Equipment (catheter, extension set, needless connector,
and dressing) are appropriate and current as per policy.
– These criteria also applies to peripheral IV’s inserted by
EMS.
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e-Module IV Insertion and Management
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Policy
• All peripheral IVs used intermittently must be flushed every 12 hours and after each use with a prefilled 5ml syringe of sterile sodium chloride 0.9% and clamped.
• All IVs are started with an medlock extension set attached to the catheter.
Medlock Extension set
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Site Selection
• Carefully examine both arms for most appropriate vessels
• Most commonly used veins for placement of IV catheters are:
– Metacarpal
– Cephalic
– Basilic
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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
• must be placed by NP, PA or MD
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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
e-Module IV Insertion and Management
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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
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Avoid
• Joint regions
• Sclerotic veins
• Site near recent complication
• Site under restraints; Inner wrist
• Locations with impaired circulation
• Legs and feet
e-Module IV Insertion and Management
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Getting Started
e-Module IV Insertion and Management
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Ensure a valid written order
Date
9/3/10
Time
1230
Order
IV Lock
Signature
Bob Cohen,MD
Contact #
Beeper 1913
e-Module IV Insertion and Management
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Wash Hands
• Standard infection control practices require the use of aseptic technique.
e-Module IV Insertion and Management
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Identify Patient –
Every Patient - Every Encounter
e-Module IV Insertion and Management
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Check for Allergies
• Check the allergy band.
• Ask patient if he/she has any known reactions to ChloraPrep or anything else.
e-Module IV Insertion and Management
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Explain Procedure to Patient
• Tell the patient what you are going to do
e-Module IV Insertion and Management
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Equipment
• IV start kit
• Angiocatheter
• CLAVE Extension Set
• Saline IV flush
e-Module IV Insertion and Management
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Prime CLAVE Extension Set
• Flush extension set with normal saline.
• Clave must be cleansed with alcohol after initial flush whenever IV lock is accessed
e-Module IV Insertion and Management
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CLAVE (bigger picture)
• Never use needles or blunts
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Peripheral IV Start Kit contents:
• Drape
• Tourniquet
• Gloves
• ChloraPrep
• 2X2 gauze
• Hubguard
• Alcohol prep
• Dressing
• Label
• Tape
e-Module IV Insertion and Management
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Open the IV Start Kit
e-Module IV Insertion and Management
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Place Drape Under Extremity
e-Module IV Insertion and Management
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IV Angiocatheter
Open your angiocatheter
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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
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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.
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16 Gauge & Larger
Uses:
• High-risk surgical procedures
• Large fluid and blood volumes
• Rapid infusions
Uses:
• Surgery
• Improved flow rate for viscous solutions and blood transfusions
• Rapid infusions
18 Gauge
e-Module IV Insertion and Management
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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
Uses:
• Most routine infusions
– Delivery of antibiotics
– Hydration therapy at slower rates
• Small or fragile veins
22 Gauge
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IV INSERTION VIDEO
Click below to watch a 4 minute video of IV
insertion technique using the angiocatheter
utilized at NSLIJHS.
http://www.bd.com/infusion/products/ivcatheters/autoguard/flash/video.asp
e-Module IV Insertion and Management
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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.
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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 Signs and symptoms of complications What and when to report signs and symptoms to the health care team Activity and restrictions
How to care for the line
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Document in appropriate area of medical
record:
• Date of insertion
• Time of insertion (in military time)
• Anatomic location of the insertion site
• Type and gauge of catheter
• Patient tolerance
• Patient teaching
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An Untoward Event…..
• Provide appropriate intervention
• Document in progress notes
• Include description of event
– multiple attempts
– hematoma
– infiltration
…………….
infiltration
hematoma Vessicant infiltration
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Adding IV solution to your newly inserted IVLock
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Peripheral IV (PIV) tubing policy
• PIV tubing is changed every 96 hours
• Exceptions: -PPN tubing every 24 hrs
-Blood and blood products every 4 hours or with each transfusion
-Lipid based medications every 12 hours.
-IV tubing used for intermittent administration of IV fluid and medications will be changed every 24 hours.
PIV fluid bag is changed every 24 hours.
Peripheral IV (PIV) fluid policy
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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.
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IV site assessment policy
• PIV site should be reassessed every 2 hours and documented on the patient care record.
• Assessment includes determining if: dressing is dry and intact, and the site is without redness, swelling, drainage, or pain.
• Frequency for monitoring may be increased based upon prescribed therapy (i.e. chemo, blood, PPN, medications), the condition and age of the patient, and practice setting.
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Attaching an IV infusion
• IV fluid bag (per order)
• IV tubing
• Tubing and bag labels
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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
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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).
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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
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You have completed this module
Competency validation will occur through return demonstration of an IV insertion.
e-Module IV Insertion and Management
References
NSLIJHS System Nursing Policy and Procedure Committee (2013, June 11). IV insertion (peripheral) adult. Retrieved from: https://nslijhp.northshorelij.com/NSLIJ/policies/Pages/default.aspx
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e-Module IV Insertion and Management
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Post Test
It is required that you take an online post test after module completion.
Click on this Link to Access:
https://nslijhp.northshorelij.com/nursing/EWD/Pages/NursingQuizSystemSYS.aspx?user_facility=system&user_quiz=system-IV-insertion
Passing score = 100%