VENOUS ACCESS: INTRAVENOUS (IV) CONVERSION TO SALINE

LOCK: PROCEDURE

POLICY A Registered Nurse (RN) may convert a continuous intravenous (IV) infusion to a saline lock, if the IV is being used to keep vein open (TKVO). This may be done at the RN’s discretion without a specific medical order. This policy applies to the use of saline locks for stable, term or near-term infants (> 34 weeks), requiring IV access just for medications or periodic infusions. Converting a continuous infusion to a saline lock on infants < 34 weeks requires a physician’s order (as there is minimal literature supporting long-term use of saline locks in the premature population).

Guidelines for maintaining saline locks: Flush IV with 0.5 to 0.7 mL Sodium Chloride 0.9%, without preservative, every 8 hours.

PROCEDURE Gather Equipment 1. Sodium Chloride 0.9%, without preservative 2. 3 mL syringe with 2 mL of Sodium Chloride solution 3. Extension tubing with injection cap 4. Chlorhexidine/alcohol swabs (2% chlorhexidine gluconate with 70% isopropyl alcohol swabs 5. tape

Procedure Notes 1. Prepare saline flush 2. Clamp extension tubing 3. Turn infusion pump off, clamp IV, and disconnect infusion tubing. 4. Scrub injection cap with chlorhexidine/alcohol swab for 30 seconds. Allow to air dry for 60 seconds. 5. Attach 3 mL syringe to injection cap and flush with . Maintain positive pressure by clamping while saline solution. Flush IV device via injection cap instilling last 0.1 mL of flush. Never empty the with saline solution. syringe. 6. Clamp extension tubing 7. Remove syringe 8. Secure tubing to patient with tape

DOCUMENTATION . Procedure and time . Patency of IV . Amount of saline flush (recorded as separate infusion on flow sheet and to be included in fluid balance) . Patient response to procedure

REFERENCES Arnts, I.J.J., Heijnen, J.A., Wilbers, H.T.M., van der Wilt, G.J., Groenewoud, J.M.M., & Liem, K.D.., (2011).

Policy NN.10.06 Neonatal Program Policy & Procedure Manual Effective Date: 20-JUL-2012 Page 1 of 2 Refer to online version – Print copy may not be current – Discard after use

VENOUS ACCESS: INTRAVENOUS (IV) CONVERSION TO SALINE

LOCK: PROCEDURE

Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in neonates: a double blind randomized controlled study. Journal of Advanced Nursing, 67(12),): 2677-2685. CINA. (1999) Intravenous Therapy Guidelines Hanrahan, K.S., Kleiber, C., & Berends, S. (2000). Saline for peripheral intravenous locks in neonates: evaluating a change in practice. Neonatal Network, 19(2), 19-24. Kalyn, A., Blatz, S. J., & Pinelli. (2000). A comparison infusion and intermittent flushing methods in peripheral intravenous catheters in neonates. Journal of IV Nursing, 23, 146-53. Schultz, A. A., Drew, D., & Hewitt, H. (2002). Comparison of normal saline and heparinized saline for patency of IV locks in neonates. Applied Nursing Research, 15(1), 28-34.

Policy NN.10.06 Neonatal Program Policy & Procedure Manual Effective Date: 20-JUL-2012 Page 2 of 2 Refer to online version – Print copy may not be current – Discard after use