Mimi Bartholomay RN MSN AOCNMimi Bartholomay RN MSN AOCNTheresa Evans - PDF document

1 Mimi Bartholomay, RN, MSN, AOCNMimi Bart
Mimi Bartholomay, RN, MSN, AOCNMimi Bartholomay, RN, MSN, AOCNTheresa Evans, RN, MSNTheresa Evans, RN, MSN Peripheral IV (PIV)Peripheral IV (PIV)Benefits:Short--term access, up to 96 hours (exception is term access, up to 96 hours (exception is pediatrics: no routine replacement of catheter)pediatrics: no routine replacement of catheter)Simple transparent semiSimple transparent semi--permeable membrane permeable membrane dressing (TSM)dressing (TSM)Considerations:NO central

2 concentrationsNO central concentrations
concentrationsNO central concentrationsNOT in an arm status post lymph node dissection NOT in an arm status post lymph node dissection (LND)(LND)NOT in an arm with an NOT in an arm with an arterioarterio-venous fistula (AVF)venous fistula (AVF) Peripheral CathetersPeripheral CathetersPeripheral IV (PIV)Peripheral IV (PIV)Catheter is less than 3Catheter is less than 3””(7.5cm) in length(7.5cm) in length“Angio”Saf-tt--intima(winged butterfly)(winged butterfly)InsyteAutoguard

3 (straight)Jelco(OR)Nexiva(CT scan power(
(straight)Jelco(OR)Nexiva(CT scan power(CT scan power--injector tolerant)injector tolerant) PIV PIV -It’s All in the Detailss All in the Details……Site selection/Considerations:Site selection/Considerations:Avoid areas of flexionAvoid areas of flexionIn general, start distally in hand and progress In general, start distally in hand and progress proximally to preserve peripheral access. Some proximally to preserve peripheral access. Some therapies, such as vesicants, should

4 not be infused therapies, such as vesic
not be infused therapies, such as vesicants, should not be infused through a hand, wrist, or through a hand, wrist, or antecubitalantecubitalvein if at all vein if at all possiblepossibleConsider individual situations i.e. arm restraints, one Consider individual situations i.e. arm restraints, one arm restrictions, crutches, wheelchairsarm restrictions, crutches, wheelchairsType and gauge of catheter:Type and gauge of catheter:Use appropriate gauge catheter to meet infusio

5 n Use appropriate gauge catheter to meet
n Use appropriate gauge catheter to meet infusion needs, prevent vessel damage, and complicationsneeds, prevent vessel damage, and complications YELLOWYELLOWagile, small veins. Not recommendagile, small veins. Not recommendvessel fragility.vessel fragility.small veins; small veins; . Used for meds, hydration, blood . Used for meds, hydration, blood GREENGREEN multiple transfusions multiple transfusions=16 G Used during major surgeries; patients requir=16 G

6 Used during major surgeries; patients
Used during major surgeries; patients requir 24 place new PIV when outdated place new PIV when outdated IV AssessmentIV AssessmentNursing assessmentNursing assessmentPatient comments/complaintsPatient comments/complaintsWhat is insertion date?What is insertion date?Any swelling/edema notedAny swelling/edema noted……•Does transparent dressing looking taut?Does transparent dressing looking taut?••Is ID bracelet tight?Is ID bracelet tight?••Is skin blanched or cool to touch

7 ?Is skin blanched or cool to touch?••Is
?Is skin blanched or cool to touch?••Is there a positive blood return?Is there a positive blood return?••Does arm appear to be the same size as the other arm?Does arm appear to be the same size as the other arm?Any redness (Any redness (erythemaerythema) at insertion site?) at insertion site?Leaking or bloody insertion sites?Leaking or bloody insertion sites?Any resistance to flushing?Any resistance to flushing?Document assessment per policyDocument assessment per policy Va

8 ncomycininfiltrationRetrieved from www.i
ncomycininfiltrationRetrieved from www.iv-therapy.net 10/6/09 Same insertion procedure as a PICCSame insertion procedure as a PICCNO Dialysis fistula in same arm NO Dialysis fistula in same arm Retrieved from http://www.bardaccess.com with permission 10/6/09Retrieved from http://www.rnao.org/pda/vad/overview.html 7/14/10 Midline Care and MaintenanceMidline Care and MaintenanceAdults/Adolescents:Minimum of 5ml saline; recommended 10ml of salineMinimum of 5ml saline; recomm

9 ended 10ml of saline3ml heparin (10 unit
ended 10ml of saline3ml heparin (10 units/ml) = 30 units heparin3ml heparin (10 units/ml) = 30 units heparinPediatrics:2F catheter: 1ml heparin (10 units/ml) = 10 units heparin2F catheter: 1ml heparin (10 units/ml) = 10 units heparin2.6F catheter or larger: 22.6F catheter or larger: 2--3 ml heparin (10 units/ml) = 203 ml heparin (10 units/ml) = 20--30 units heparin30 units heparinBlood drawing not recommended.Blood drawing not recommended.Dressing protocol: same as PICCDre

10 ssing protocol: same as PICCMaximum inf
ssing protocol: same as PICCMaximum infusion rate: as patient condition Maximum infusion rate: as patient condition warrantswarrantsNo tPAuse for catheter occlusions (peripheral use for catheter occlusions (peripheral catheter)catheter) Short Jugular linesShort Jugular linesBenefits : Benefits : Short term peripheral access No CXR needed for catheter No CXR needed for catheter placementplacementConsiderations:NOT used for continuous NOT used for continuous vesicants vesi

11 cants NO Dextrose concentrations NO Dext
cants NO Dextrose concentrations NO Dextrose concentrations �10%�10%NO Central concentrations NO Central concentrations Short jugular lines: care and Short jugular lines: care and maintenancemaintenanceFlushing: Minimum 2ml saline Minimum 2ml saline No heparin flush (it is a peripheral line) No heparin flush (it is a peripheral line) Dressing protocol:Dressing protocol:Simple transparent dressingComplications:Location-related Needs stabilizationNeeds stabiliz