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Intravenous And/Or Peripheral Saline Lock Insertion and Maintenance

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Title: INTRAVENOUS AND/OR PERIPHERAL
SALINE LOCK INSERTION AND MAINTENANCE

ID Number: 1118

  • Authoriza tion
  • Sourc e: Nursing

Da te Revised: September 2013 Da te Effec tive: Ma y 1999 Da te Rea ffirmed: Ma y 2015

Sc ope: SHR & Affiliates

[X] SHR Nursing Pra c tic e C ommittee

Any PR I N T E D ve   r si o n of t his d oc   ume nt   i s o n l y a c   c u r a t e   up to the d a t e o f p r i n ting 22- J u l -15. S a s k a t o on H e a l th Re   g i o n (SHR) c a n not   gua r a n t e e t he c   urre nc y   o r ac c u r a c y   of any p r i n te   d p o l ic   y. A l w ays   r e fe r to   the P o l ic   ie s   a nd P r o c   e du r e s   site f o r   t he mo s t c   urre nt   ve rsi o ns   of doc   ume nts   i n e   ffe c t.   SHR a c   c e p t s   no re   s p on s i b i lity f o r u s e   o f t his m a t e   ri a l by any pe   r s o n or o r g a n iz a t i o n not a s s o c   i a t e d w i th SHR. No p a r t o f t his d oc   u me nt   may be r e   p r o duc e d   i n a n y f o r m f o r pub l ic   a t i o n w i th o ut pe r m i ssi o n of S HR.

DEFINITIONS

Flushing – Injec tion of a solution into the intra venous (IV) c a theter/c a p to prevent mixing of inc ompa tible solutions a nd c lea n the c a theter of blood or fibrin buildup.

Turbulent flush technique – A method of flushing using a “stop-sta rt” tec hnique whic h “sc rubs” the

inside of the c a theter lumen, preventing the build-up of fibrin or medic a tion residue.

1. PURPOSE

1.1 To minimize the risks of infec tion a nd other c omplic a tions a ssoc ia ted with the insertion a nd ma intena nc e of intra venous c a theters.

2. POLICY
2.1 Who may start IV

• RN/RPN/G N c ompetent in IV sta rts (NIC U-Level 2 orienta ted RN only) • Nursing Students under direc t RN/G N/RPN/LPN/G PN supervision • LPN/G PN who ha ve suc c essfully c ompleted the IV/Blood Administra tion C ourse • Home Intra venous Thera py Progra m (HITP) – RN’s only

2.2 A presc riber order is required to sta rt a n IV exc ept in a n emergenc y situa tion or for resta rts.

2.3 Special C onsiderations

2.3.1 Ma ximum of 2 insertion a ttempts per nurse, then c onsult more experienc ed personnel. 2.3.2 Site will be monitored visua lly every shift or point of c a re c onta c t (refers to Home C a re visit), Pedia tric s: q1h when IV fluid is infusing a nd when pa tient c ompla ins of pa in or tenderness a t IV site or ha s a n unexpla ined fever.

2.3.3 Ha nd hygiene will a lwa ys be performed a s per polic y before a nd a fter pa lpa ting c a theter insertion sites a s well a s before a nd a fter inserting, repla c ing, a c c essing or repa iring a n IV c a theter or dressing a n IV site.

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  • P o l ic ie s & Pr o c e du r e s: Intr a ve nous and/or Pe r i p he r a l S a l i n e   l o c k I ns e r t i o n and Ma i n te n a nc e
  • I . D. #   1118

2.3.4 The nurse will a ttempt to a spira te the c a theter for blood return to a ssess c a theter func tion prior to use.

2.3.5 Direc t luer loc k c onnec tions will be used for c ontinuous infusions. 2.3.6 C ontinuously running solutions c onta ining medic a tions (e.g. hepa rin, insulin) must run on the prima ry port (A) of the IV pump.

Note: A l l C h e mo t h e r a py mu s t b e   i nfus e d on s e c onda r y p o r t ( B).

2.3.7 IV ba gs a nd syringes with medic a tion a dded by nurse must ha ve a medic a tion la bel c ompleted a nd a tta c hed.

2.3.8 Pedia tric a rea s - IV pump must be used with a ll IV infusions. All IV ba gs a nd syringes must be la beled, even if no medic a tion is a dded.

2.4 IV site preparation

2.4.1 C hlorhexidine 2% or C hlorhexidine 2%/Alc ohol 70% will be used to c lea nse site.

Note: F o r i n f a n ts un d er 2 month s , use   A l c o hol 70 % . Note: A nt i s e p t ic m ust   b e a l l o wed t o a i r   d r y o n i n s e r ti o n s ite b e f o r e c a t h e t e r i n s e r ti o n.

2.4.2 Pedia tric a rea s: a topic a l a na esthetic c rea m ma y be a pplied (presc riber order required) before IV insertion to ma na ge pa in. See produc t instruc tions.

2.5 IV site dressing

2.5.1 Sterile, tra nspa rent, semi permea ble dressing is rec ommended. 2.5.2 Sterile ga uze dressing will be used with sterile ta pe to sec ure hub (e.g. Steri-strips) when a pa tient is dia phoretic or if site is bleeding or oozing until resolved.

2.5.3 Dressing will be repla c ed when da mp, loosened or visibly soiled or when IV site c ha nged.

2.5.4 The da te a nd time of IV insertion will be written on the dressing. 2.5.5 Pedia tric IV ta ping proc edure:
2.5.5.1 Use a tra nspa rent, semi permea ble dressing to sec ure c a theter. 2.5.5.2 Keep site visible – do not ta pe over. 2.5.5.3 Ta pe fingers/toes a nd wrist/a nkle to IV boa rd (if using). Lea ve one end of ta pe doubled over for ea sy remova l.
2.5.5.4 Use double sided ta pe then c over with single sided ta pe to sec ure a rm/leg to the a rm boa rd (NIC U: ma y dea den the ta pe with c otton ba ll to protec t the skin).
2.5.5.5 Use a n IV site protec tor (i.e. IV House®) to protec t the IV site. 2.5.5.6 Use tubula r ga uze or a thin c otton soc k to c over site or over a rm/foot boa rd if required. Do not use ga uze ba nda ge wra p.
2.5.5.7 No sc issors to be used when removing ta pe or a rm/footboa rds. 2.5.5.8 C hec k ta pe/a rm boa rds every shift a nd c ha nge q48-72h (exc ept ta pe a t IV site).

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  • I . D. #   1118

2.6 Flushing

2.6.1 The IV c a theter will be flushed prior to use to a ssess c a theter func tion. 2.6.2 The IV c a theter will be flushed following a c c ess using turbulent flush tec hnique to ma inta in pa tenc y.

Note: Pri o r to   ac c e s sing   a n y p o r t o r c ap, c l e an t he surf a c e w i th a n a l c o hol s w a b f or
15 s e c onds u s ing fric ti o n and a tw i sting m ot i o n.

2.6.3 Adults: 3mls 0.9% sodium c hloride every 24 hours a nd prn following ea c h use.
Pedia tric s: 1-2 mls of 0.9% sodium c hloride q6h & prn.

Note: PIC U:   0.5–1 ml 0.9% s o d i um c hl o r i d e   p r e a n d b e t w e en med i c   a t i o n(s) th e n 1 -2 ml 0.9% so d i um c hl o r i d e   f o l l o w i n g m e d i c   a t i o n.

Neona tes: 0.5 mls (or double c a theter & extension a mount) 0.9% sodium c hloride every 4-6 hours.

2.7 IV site change

2.7.1 Adults: site will be c ha nged every 96 hours or a s soon a s possible when a septic tec hnique during insertion c a nnot be ensured or with signs of phlebitis or infec tion or when dysfunc tiona l. Pedia tric s: site will be c ha nged only when dysfunc tiona l.

2.8 Tubing & Solution Change

2.8.1 C ontinuous use tubing, sec onda ry sets & a dd-on devic es (ie. medic a tion filters, bridges, a da pters) will be c ha nged every 96 hours, with IV site c ha nge or immedia tely if c onta mina tion or system integrity suspec ted

Note: C e r t a i n m ed i c a t i o ns r e q u ire   m o r e fr e q u e n t tu b i n g / filt e r c h ange s . R e f e r t o IV
Med i c a t i o n R e f e r e n c e   Manua l .

2.8.2 Lipid a nd a ll Pa rentera l Nutrition (PN) solutions, filter, a da pters & tubing will be c ha nged every 24 hours.

2.8.3 Blood & blood produc ts - a s per “Blood, Blood C omponents a nd Pla sma Protein
Produc ts - Administra tion of” polic y.

2.8.4 All tubing will be la beled with the da te & time it wa s sta rted, da te & time to be disc a rded or c ha nged, a nd initia ls of c a regiver.

2.8.5 IV solutions must be c ha nged a t lea st every 96 hours, with tubing c ha nges a nd with IV site c ha nges

Note: M ed i c a t i o n add i ti v es and s p ec i fic   s o l u ti o ns may r e q u ire m o r e fr e q u e n t c hanges due   to s t a b i lity; r e f e r t o s p ec i fic   p o l ic i e s a n d   r e f e r e n c e s .

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  • I . D. #   1118

2.9 Pump Pressures/Alarm

2.9.1 Pedia tric a rea s: Defa ulted to 2 PSI. Pa tient a nd IV pump pressures will be c ha rted a s per unit polic y. Neona tes: IV pump pressure will be noted a t sta rt of infusion a nd limit set a c c ordingly. C ha nges in PSI will be c hec ked hourly. Adults: Pump pressures defa ult setting - 10 PSI.

2.10 LPN/GPN Role – IV Therapy

Note: R e f e r t o   Append i x A.

3. PROCEDURES

Note: R e f e r t o   P e r r y , Pott e r & O s t e n d o r f 2014 C linic a l N ursing Skills & T e c h n i q u e s 8th E d i ti o n.

3.1 Insertion of a Periphera l Intra venous C a theter: pa ges 697 - 708 3.2 C ha nging Solutions, Regula ting Intra venous Flow Ra te, C ha nging Infusion Tubing,
Disc ontinuing Short Periphera l Intra venous Ac c ess: pa ges 708 - 724.

3.3 Document

••••••

Insertion a nd ongoing c a re of IV on a ppropria te rec ord every shift a nd prn C a re of site, da te of site c ha nge a nd loc a tion of site on the c a re pla n Rea son for fa iling to re-esta blish new IV site a s indic a ted Da te IV wa s esta blished on the IV dressing Solution type a nd volumes on a fluid ba la nc e sheet. Medic a tions a dded to solution on medic a tion a dministra tion rec ord.

4. REFERENC ES

Americ a n Hea rt Assoc ia tion (2012) PALS Provider Ma nua l Assoc ia tion for Professiona l in Infec tion C ontrol a nd Epidemiology – G rota , P. (2014) APIC Text in Infec tion C ontrol & Epidemiology. 4th Edition. Wa sh, USA: C ha pter 24 –Intra va sc ula r Devic e Infec tions

C enters for Disea se C ontrol a nd Prevention (2011). G uidelines for the Prevention of Intra va sc ula r

C a theter – Rela ted Infec tions. http://www.c dc .gov/hic pa c /bsi/bsi-guidelines-2011.html

C ollege of Physic ia ns a nd Surgeons of Sa ska tc hewa n -La bora tory Qua lity Assura nc e Progra m (2004) Tra nsfusion G uidelines for Hospita ls in Sa ska tc hewa n.

C ompetenc y Profile for Lic ensed Pra c tic a l Nurses of Sa ska tc hewa n, Version 2 (July 11, 2005): Sa ska tc hewa n Assoc ia tion of Lic ensed Pra c tic a l Nurses a nd Alberta Hea lth a nd Wellness Hea lth Workforc e Pla nning Bra nc h, Edmonton.

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  • Saline Solution

    Saline Solution

    Preparing Saline Solution What will I need to prepare saline solution? Table salt (Sodium Chloride) Measuring Teaspoon Clean jar or other container with a lid. Reuse this container. What is the recipe for saline solution? 2 Teaspoons of table salt 1000 mL (4 cups) of warm tap water How do I prepare saline solution? Wash your hands well and rinse them with warm water. Pour 1000 mL (4 cups) of warm water Add 2 teaspoons of table salt into your container. Measure exact amount of salt to make sure it is correct. Mix until salt is completely dissolved. Label your container. *** Cut along dotted lines and tape onto your container*** _______________________________________________________________________ Normal Saline Recipe 2 Teaspoons of table salt 1000 mL (4 cups) of warm tap water -------------------------------------------------------------------------------------------------------------- Pediatric Surgery, C. S. Mott Children’s Hospital (734) 764 - 4151 - 1 - If you use well water, boil it for ten minutes, let cool for one hour, and then boil another ten minutes before mixing with salt. Normal saline solution can be stored at room temperature for three days in a closed container. What is the contact information? If you have any question, problems or concerns call the Pediatric Surgery clinic from 8-5:00pm Monday thru Friday, 734-764-4151. After 5:00pm or on the weekends if you have urgent issues call hospital paging at 734 936-4000 and ask the operator to page the Pediatric Surgeon “on call”. Disclaimer: This document contains information and/or instructional materials developed by the University of Michigan Health System (UMHS) for the typical patient with your condition.
  • Crystalloids and Colloids Intravenous Therapy

    Crystalloids and Colloids Intravenous Therapy

    CRYSTALLOIDS AND COLLOIDS INTRAVENOUS THERAPY NOAH CARPENTER, MD Dr. Noah Carpenter has practiced as a thoracic and peripheral vascular surgeon. He completed the Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver Island, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. Abstract A majority of hospital patients receive some form of intravenous therapy during a hospital stay, and a significant number of those patients require fluid replacement in the form of volume expanders. There are two types of volume expanders, crystalloids and colloids, and each has advantages and disadvantages. While there continues some controversy in the research over which volume expander is the best choice during specific situations of resuscitation, general medical wisdom exists that allows health clinicians to understand the best use of each and to provide patients with the most effective treatment possible.
  • Instructions After Septoplasty And/Or Turbinate Reduction

    Instructions After Septoplasty And/Or Turbinate Reduction

    INSTRUCTIONS AFTER SEPTOPLASTY AND/OR TURBINATE REDUCTION 1. Diet Patients may resume a regular diet without special restrictions. Many patients note a scratchy throat from the endotracheal tube for the first day and may prefer soft food initially. 2. Activity Light to moderate activity is recommended. Avoid heavy lifting and straining for the first week after surgery. Nose blowing initially should be gentle and minimal. Forceful nose blowing can lead to nasal bleeding. Elevating the head while resting or sleeping may be helpful. 3. Packing Your surgeon may place packing and/or plastic splints within your nasal cavity after the surgery. Your surgeon will let you know when these will be removed. 4. Nasal Saline Irrigation Your physician may recommend mechanically cleaning your nose and sinuses with nasal saline. This can remove blood and mucus from the nose and help with healing after the surgery. Nasal saline spray is available over the counter. You can also make a saline solution with the following recipe: -1/2 tsp table salt -12 ounces of water (clean tap or boiled water) -Pinch of baking soda 5. Pain Some pain after nasal surgery is expected. It is generally of moderate severity. Take the pain medicine as prescribed by your physician. 6. Fever Low-grade temperature after nasal surgery is common. You should notify our office if you temperature is 101ºF or greater. 7. Bleeding Some bloody nasal and postnasal drainage after nasal surgery is expected. You should expect light bloody drainage for the first 1-2 days. Call the office if your bleeding becomes excessive.
  • 0.18% Saline Or 4% Glucose IV Solution Safety Risks In

    0.18% Saline Or 4% Glucose IV Solution Safety Risks In

    1 MHRA UK PUBLIC ASSESSMENT REPORT Intravenous 0.18% saline/4% glucose solution (‘hypotonic saline’): do not use in children except in specialist settings under expert supervision October 2012 Plain-language summary 2 1. Introduction 4 2. Background 4 3. Results 9 4. Discussion 17 5. New advice 17 6. References 19 7. Glossary 21 2 PLAIN-LANGUAGE SUMMARY KEY MESSAGE: Intravenous hypotonic saline (0.18% saline/4% glucose solution) can cause dangerously low levels of sodium in children, which in some cases has lead to swelling of the brain and death. Therefore, 0.18% saline/4% glucose solution must not be used in children aged 16 years or less, unless it is in a specialist setting, such as kidney, heart, liver, high- dependency, or intensive care units, and there is expert medical supervision. The child must be carefully monitored throughout treatment. Background The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK government agency responsible for regulating medicines and medical devices. We continually review the safety of medicines and vaccines in the UK1, and inform healthcare professionals and the public of the latest updates through several means, including public assessment reports. This report discusses a medical solution used in hospitals called hypotonic saline (0.18% saline/4% glucose), and its risks and benefits when used in children. Hypotonic saline is given to patients intravenously2 by health professionals in a hospital to maintain or replace their fluid and salt requirements. It has been used for this purpose for since the 1950s in both adults and children. There are several solutions of different compositions available in hospitals for intravenous fluid replacement therapy.