Successful IV Starts Revised February 2014

Transcription

1 Successful IV Starts Revised February 2014

2 Why Intravenous Therapy? Used for access to the body s circulation Indications: Administer fluids, blood, medications, and nutrition Obtain laboratory specimens Correct electrolyte imbalances

3 Patient History and Assessment What Needs to Be Considered? Fluid volume status: Is the patient dehydrated or over-hydrated? Condition of veins: Does the patient need a PICC, central line or midline instead of a peripheral IV? Clinical conditions to consider: Does the patient have a history of a mastectomy, have a dialysis access, have impaired circulation of the extremity, have a fracture proximal to infusion area and/or is this a pediatric patient? Prior history with IV therapy (fears, anxiety) Which is the dominant extremity of the patient?

4 Catheter Sizes - Learn your colors! 18 gauge: green Medium to large bore needle 20 gauge: pink Most common size for adults 22 gauge: blue Used for adults and children; can be used for blood products 24 gauge: yellow Used for infants, neonates and small veins

5 Peripheral IV Site Selection: Arms and Hands

6 Initiating a Peripheral IV 1. Know your colors. Choose the appropriate size catheter for the patient and the clinical situation. 2. Verify any allergy history (including medications, latex, betadine, iodine, chlorhexidine, or tape). 3. Review patient history for clinical conditions that may affect the site placement. 4. Verify order for IV or saline lock start. 5. Identify patient verbally with two patient identifiers and check the patient ID bracelet. 6. Explain the procedure to the patient. 7. Gather supplies Start Kit (non-sterile gloves, IV catheter, stabilization device, and extension tubing).

7 Procedure for Starting a Peripheral IV 1. Wash hands and don nonsterile gloves. 2. Prime your extension tubing or end cap with normal saline. 3. Apply a tourniquet and select your site. 4. Be confident and positive with the patient. 5. Methods to improve venous distention include: Encourage patient to pump hand Dangle the arm below body Tourniquet should be tight enough to slow blood flow but not stop it. Apply heat over the selected site for a few minutes

8 7. Remove hair as necessary. 8. Prepare large area with chlorhexidine and allow to dry. If patient is allergic to chlorhexidine, use the providone iodine prep in a circular motion. Allow to dry and follow with alcohol. 9. Insert the catheter with the bevel up into the skin at a low angle of degrees.

9 10.Upon flashback visualization, lower the catheter almost parallel to the skin. 11.Advance the stylet a few millimeters more to ensure catheter is in the vein and then gently advance the catheter off the stylet. 12.Release the tourniquet and occlude the blood flow above the tip of the catheter. 13.Engage the safety devise to withdraw the stylet from the catheter.

10 Finishing the Peripheral IV start 1. Attach the pre-filled extension tubing set. 2. Attach the securement devise to the catheter hub. If appropriate, prep the skin on either side of the IV catheter hub. 3. Apply transparent occlusive dressing. 4. Label the dressing with date, catheter size, and your initials. 5. Tape extension tubing or end cap securely. 6. Flush the extension tubing or end cap with normal saline to ensure patency.

11 Documenting Your IV Start Document in SCM under vascular access Enter new time column and document insertion Make sure to right click and modify row label to include catheter gauge, date, site and type of catheter.

12 Documenting you IV Start Remember, you must document all attempts to start an IV even if unsuccessful.

13 Managing Difficult Sticks Use warm packs Lightly tap vein Have patient dangle arm below the body and then put the tourniquet on Apply a 2 nd tourniquet about 3-4 inches below the first tourniquet Have the patient relax..engage them in conversation to help them relax Attempt IV starts only 2 times and then ask for back up help If all else fails, re-apply heat and ask an IV Super Starter or another co-worker for assistance

14 Who Needs a PICC Line? Those who will be on antibiotic therapy for longer than a few days Those receiving TPN Those receiving vesicants or irritants longer than a couple of doses or longer than a short period of time Those will very poor IV access choices who will need extended IV s and lab draws

15 When to Consider a Midline Consider a Midline if the patient has: Poor access with frequent restarts Difficult lab draws IV fluids NOT requiring a central access IV or medication therapy that will last less than 29 days

16 Complications of IV Therapy Infiltration Thrombophlebitis Bacteremia Circulatory overload Air embolism Mechanical failure Hemorrhage Extravasation

17 Infiltration is the inadvertent administration of a non-vesicant solution or medication into the surrounding tissue Clinical Presentation Swelling Skin cool to touch Pain at insertion site Decreased or absent IV flow

18 Management of Peripheral IV Infiltration 1. Stop IV infusion and discontinue IV 2. Elevate extremity 3. Apply heat or ice for comfort 4. Add parameter under SCM vascular access for vascular infiltrate 5. Document in SCM and Safety Zone Portal per Health First policy CP Restart IV in alternate extremity or proximal site

19 Phlebitis indicates irritation and/or inflammation to the vein Clinical presentation Pain Erythema which may follow the course of the vein Edema Warmth at affected area Hardened vessel

20 Management of Phlebitis 1. Stop IV infusion and discontinue IV 2. Add parameter in SCM under vascular access for vascular phlebitis 3. Document in SCM and Safety Zone Portal per Health First policy CP Restart IV in unaffected extremity or proximal to site 5. Apply heat to affected area If an IV is not good, remove it! No IV is better than a bad IV in an emergency.

21 Central Line-Associated Bloodstream Infections (CLABIs) These infections result in thousands of deaths each year and billions of dollars in added healthcare costs yet these infections are preventable! Approximately 90% of these infections occur with CVCs Remember, PICC lines are also central lines

22 Prevention of CLABSIs Perform hand hygiene before and after inserting, replacing, accessing, or dressing a central line Use Maximal Barrier Precautions during insertion A mask, cap, sterile gown and sterile gloves are to be worn by all healthcare personnel involved in the central line insertion procedure The patient must be covered with a large sterile drape during insertion Chlorhexidine Skin Antisepsis Use a chlorhexidine-based antiseptic for skin preparation in patients older than 2 months of age The antiseptic solution must be allowed to fully dry before making the skin puncture for central line insertion

23 After Insertion of Central Lines Disinfect catheter hubs, needleless connectors and injection ports with alcohol before accessing the catheter Before accessing catheter hubs or injection ports, clean them with 70% alcohol to reduce contamination. Scrub the hub! Assess the need for the central line on a daily basis. Remove unnecessary central lines promptly.

24 Central Line Sterile Dressing Change 1. Wash hands, don non-sterile gloves, set up supplies and remove old dressing. 2. Remove gloves and wash hands again. Open CVC or PICC dressing kit. Apply face mask and don sterile gloves. 3. Cleanse site with chlorhexidine OR alcohol applicators (x 3) and then betadine applicators (x 3). Start at site and work outward in a circular motion. Allow to air dry fully. 4. Apply antimicrobial patch unless patient is allergic to chlorhexidine. Use hemostatic powder for a bleeding site. Change the antimicrobial dressing every 7 days and change a gauze dressing every 48 hours (per Health First policy CP 2.02)

25 Central Line Sterile Dressing Change (continued) 5. Apply occlusive dressing. Date and label the dressing with your initials also. 6. Document in SCM the assessment, dressing change and injection cap changes. 7. Change the catheter patency device caps (injections caps) every 7 days.