Intravenous And/Or Peripheral Saline Lock Insertion and Maintenance

Polic ies & Proc edures Title: INTRAVENOUS AND/OR PERIPHERAL SALINE LOCK INSERTION AND MAINTENANCE ID Number: 1118 <ul style="display: flex;"><li style="flex:1">Authoriza tion </li><li style="flex:1">Sourc e: Nursing </li></ul>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. P a ge 1 of 6 <ul style="display: flex;"><li style="flex:1">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 </li><li style="flex:1">I . D. # 1118 </li></ul>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). P a ge 2 of 6 <ul style="display: flex;"><li style="flex:1">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 </li><li style="flex:1">I . D. # 1118 </li></ul>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 . P a ge 3 of 6 <ul style="display: flex;"><li style="flex:1">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 </li><li style="flex:1">I . D. # 1118 </li></ul>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. <a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">http://www.c dc .gov/h</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">i</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">c </a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">p</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">a c /b</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">s</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">i/</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">b</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">s</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">i-</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">g</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">u</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">i</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">d</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">e</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">l</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">in</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">e</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">s</a><a href="/goto?url=http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html" target="_blank">-2011.html </a>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.

Intravenous And/Or Peripheral Saline Lock Insertion and Maintenance

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