Transcript IV Catheter Care: Peripheral and Central Policy Review Description This module is an overview of the Aurora Health Care Intravenous (IV) Catheter Care: Peripheral.

IV Catheter Care: Peripheral and
Central Policy Review
Description
This module is an overview of the Aurora Health Care
Intravenous (IV) Catheter Care: Peripheral & Central
(Adult) policy. This module will take about 30 minutes
to complete
For questions regarding this learning module, please
contact your Clinical Education Committee
Representative or refer to Intravenous (IV) Catheter
Care: Peripheral & Central (Adult) policy #1007 in the
Aurora Health Care Administrative Manual.
Features:
Instructions on how to navigate this course.
This course does have Sound. Your computer will
require earbuds, headphones, or speakers to hear the
narrative in the brief videos.
This course does not have Notes.
Technical contact:
If you have technical
questions please contact
the Service Desk
414-647-3520 in Milwaukee
or 1-800-889-9677
Content contact:
Lana Peters, MSN, RN
Patricia Stockhausen, MSN, RN
Created: April 2012
Reviewed:
Updated:
Course Objectives
The audience for this course includes all caregivers that care for
patients with peripheral and central intravenous devices.
• After completion of this self paced course you will
be able to:
• Apply key Intravenous policy guidelines related to
peripheral IV insertion and care.
• Discuss Intravenous policy guidelines related to Central
Venous Access Devices.
• State several key infection prevention and patient safety
guidelines that pertain to vascular access devices,
including tubings, dressings, caps, and flushes.
• Identify criteria necessary for quality blood draws from
vascular devices.
2
Your Workplace
• Follow the correct link below for your workplace specific
Intravenous guidelines
Aurora Inpatient Facilities
Includes All Medical Centers and Hospitals
Aurora Medical Group (AMG)
Aurora UW Medical Group (AUWMG)
Aurora Advanced Healthcare (AAH)
Clinic outpatient settings
• You will complete a workplace specific self-assessment after
you have reviewed your workplace specific content
3
Aurora Inpatient Facilities
All Medical Centers and Hospitals
• The following information applies to Aurora inpatient facilities,
Including all Medical Centers and Hospitals
Introduction
Hospital
• IV therapy is integral to providing safe and effective
care to all patients – regardless of the type of
intravenous device.
• This review of the policy consists of:
•
•
•
•
•
Chapter I – Peripheral IV
Chapter II – Central Venous Catheters (CVC)
Chapter III – Lines Used for CT scans
Chapter IV – Total Parenteral Nutrition (TPN)
Chapter V – Need To Know
• Many of the changes are based on the CDC and INS
2011 guidelines.
• Review the entire policy for details.
5
Hospital
Chapter I: Peripheral IVs
•
•
•
•
•
•
Insertion Guidelines
Dressings
End Caps
Tubing Guidelines
Assessment
Other
Hospital
Peripheral IV
Key Insertion Guidelines
•
•
•
•
A physician’s order is necessary to perform venipuncture,
including insertion, capping, and discontinuation of peripheral IV
catheters except in circumstances where there are existing
emergency protocols (e.g. Rapid Response Team, emergency
triage).
Scrub the skin with an antiseptic containing chlorhexidine
gluconate for 30 seconds and allow to dry for 30 seconds.
Once the site is prepared, the site cannot be touched unless a
sterile glove is used.
If using ultrasound to find a vein, sterile gel should be used
when probing for vascular access.
7
Insertion Guidelines
A nurse should attempt no
more than two IV
insertions. After a total of 4
unsuccessful attempts,
consider alternate IV
access.
Hospital
• It is recommended that any one
competency tested nurse or caregiver
attempt no more than two peripheral
IV insertions.
• After two unsuccessful IV attempts,
the nurse will contact a resource
nurse to insert IV.
• After a total of four unsuccessful IV
sticks, consider alternative IV access
with appropriate agency resources
(e.g., anesthesia, CRNA, PICC
Service, etc.).
• If no vascular access is established,
notify attending physician.
8
Hospital
Dressings
Hospital
Dressings
• Transparent dressing is the IV site
dressing of choice (INS, 2011).
• Tape is not placed under a
transparent dressing.
• The transparent dressing must be
made occlusive by pinching the
dressing around the hub of the IV
catheter or around the catheter itself
in the case of a central line.
• When securing the IV tubing, do not
overlap tape on top of the dressing.
Consider the application of a
securement device for a
peripheral catheter at risk for
dislodgment.
10
Dressings
Hospital
• Routine site care and
transparent dressing
changes are completed
when dressing is soiled or
no longer intact.
• Gauze dressings are
changed q 48 hours and
PRN.
11
Hospital
End Caps
Positive
displacement cap
MaxPlus Clear®
End Caps
•In acute care facilities, a positive
pressure IV access end cap will be
used for all IV catheters: central
lines, midline catheters, PICCs and
peripheral catheters.
•IV caps are replaced with a new
sterile cap every time the cap is
removed or disconnected or when
visibly soiled.
•Central Lines: Change needleless
components including caps with
administration tubing change every
96 hours.
•Peripheral IVs: New sterile caps are
applied when restarting the IV every
96 hours, or when the cap is
removed, disconnected, or when
visibly soiled.
Hospital
Positive
displacement
cap
MaxPlus
Clear®
When using a positive
pressure IV access
end cap for a
peripheral catheter, an
extension set should
be used.
14
End Caps – Priming and Access
•
•
Hospital
Invert and tap IV end cap (needleless
connector) while priming with saline to
purge air.
Applying friction, vigorously scrub the top of
connector with alcohol for a full 15 seconds
and allow to dry before accessing.
Invert to prime cap
•
•
The Bard Scrub Site IPA (isopropyl alcohol) device
can be used as an alternate to an alcohol wipe.
(Follow your hospital site-specific policy). Review
the manufacturer’s precautions and instructions.
Verify connection is secure to connection
tubing and valve, administer medication or
flush.
Scrub vigorously for 15
seconds and allow to dry
15
End Caps – Flushing Procedure
•
Flush a peripheral IV catheter per
manufacturer’s recommendations with
preservative free normal saline (2 mL).
•
•
•
•
•
•
•
Hospital
Every 12 hours or as ordered
Before giving medications
After giving medications
After intermittent IV therapy
Always flush with saline immediately after
blood infusion or sampling using a pushpause technique to clear the valve.
Flush positive pressure valves until clear.
When flushing positive pressure valves,
disconnect syringe, then clamp.
• Do not clamp before detaching syringe.
• Clamp after detaching the syringe.
16
End Caps - Changing
•
•
Hospital
Needleless components (e.g.. caps, Jloops) will be changed:
• If the connector is removed for any
reason.
• If blood or debris is present within the
connector.
• If contaminated.
• When the IV is restarted.
The catheter or extension set must be
clamped when changing the end cap or
when the cap is removed.
17
Hospital
Tubing
Hospital
Tubing Guidelines – GENERAL INFORMATION
•
•
•
•
The infusion tubing or channel will be labeled with the date
and time initiated.
Tubing or channel will be marked with the medication being
infused.
Stopcocks are associated with an increased risk of infection
and their use is not recommended. If a stopcock is in use, a
closed system must be established and only sterile caps
attached to the ports.
All infusion tubing should be traced back to the insertion site
to ensure the route is accurate.
19
Tubing Guidelines – When to Change Tubing
•
•
•
•
•
Hospital
Infusion tubing will be labeled with the date
and time initiated and the tubing or channel
must be labeled with the medication.
Change primary tubing every 96 hours or
with any site change (CDC, 2011; INS,
2011).
Change needleless components including
caps with administration tubing change
every 96 hours.
Intermittent IV tubing is changed every 24
hours.
Filtered tubing is changed every 48 hours
(e.g., Phenytoin, 20-25% mannitol and
amiodorone).
20
Tubing Guidelines
Hospital
• Vigorously scrub IV tubing ports with
alcohol for 15 seconds and allow
them to dry before accessing the port.
• Flush the Clearlink IV tubing port
immediately after IV push injection
with a minimum of 1ml to ensure
complete infusion of medication and
minimize risk of precipitation.
21
Hospital
Tubing Continued
•
Sterile end caps must be applied if the
primary or secondary tubing is
disconnected.
• This will help prevent
contamination to end of
intermittent IV administration set.
•
Do not leave any tubing with the end
uncovered.
To prevent contamination of the
tubing NEVER loop the tubing to itself
at another access port on the tubing.
Intermittently used IV administration
Immediately apply a sterile end
sets are changed every 24 hours.
cap to an intermittent IV that is
•
•
disconnected.
22
Hospital
Assessment/Reassessment - Prevention of
Complications
•
•
•
•
•
Hospital
Peripheral IV Catheter insertion sites will be visually inspected
and palpated approximately every 8 hours.
Remove the IV catheter if patient develops signs of phlebitis,
infection or catheter malfunctions.
Restart the peripheral IV every 4 days (96 hours).
Vascular access devices placed in an emergency situation
should be replaced as soon as possible and no later than 48
hours.
A physician order is needed for a peripheral IV site
without IV related complications to be used more than 96
hours.
24
Emergency Administration of Vesicant Drugs Hospital
• Central venous access is the preferred route to administer vesicant
drugs (e.g., Dopamine, Dobutamine, chemotherapy), TPN, or
sclerosing agents (INS, 2011).
• However, in an emergency or for short term peripheral infusion in
consultation with a physician, a nurse may infuse vesicant drugs,
TPN or sclerosing agents through a peripheral IV after performing
an assessment of the patient’s veins.
• Ongoing assessment of the site is required, every 1 to 2 hours, to
evaluate the peripheral site for pain, erythema or edema which may
be signs of IV infiltration or extravasation. Assess for vein patency
by using normal saline, not the infusing drip, to assess for blood
return.
• Note: Standard for oncology is to limit vesicant infusions to 1 hour
due to required site monitoring by nurse. If an infusion of a vesicant
will take more than 1 hour, a central line is used.
25
Midlines
•
Hospital
A midline catheter is considered a
long-term peripheral catheter because
the end of the catheter is not in the
superior vena cava. It is not a central
venous catheter.
• A midline is a 6 to 8-inch catheter
for intermediate duration (i.e.,
several weeks) of IV therapy.
• May remain in place indefinitely if no
complications.
•
•
•
Use stabilization devices for midlines.
Catheter dressing should be labeled
as midline.
RNs may discontinue midline
catheters.
26
Hospital
Chapter II: Central
Venous Catheters (CVC)
Prevention of Central Line Infections
•
•
Follow evidence-based processes to prevent
central line infections during insertion of
Subclavian CVC.
Use maximal barrier precautions including:
•
•
•
•
•
•
•
Hospital
A cap that covers all hair
Tight fitting mask
Sterile gown
Sterile gloves
Eye shield/eye protection
Chlorhexidine skin antisepsis.
Collaborate with the physician daily to review
line necessity, promptly removing
unnecessary lines.
28
Prior to Using a CVC
•
Hospital
Placement of any type of central
line catheter tip in the superior
vena cava must be verified by Xray or fluoroscopy prior to
beginning an infusion.
29
Current CVC Flushing Guidelines
April 2011
CVC device
Flush
Frequency
Subclavian
3 ml NS
Q 24 hr or after use
Tunneled Hickman – no
valve
5 ml Heparin 10unit/ml
3 x week or after use
Tunneled Groshong – with
valve
5 ml NS
Weekly or after use
PICC – with valve
5 ml NS
Weekly or after use
PICC – no valve
5ml of 10unit/ml heparin
Q 24 or after use
PowerPICC – with valve
10 ml NS
Weekly or after use
PowerPICC - no valve
1ml 10 units/ml heparin
Q 12 hr or after use
Implanted Port – no valve
5ml of 10unit/ml heparin
Q 24 hr or after use
Prior to de-accessing: 5ml of 100unit/ml
heparin
Implanted Port – with valve
5 ml NS
Weekly or after use
CVC – Flush Using Push-Pause Method
•
Hospital
Where indicated, use a Push-Pause pulsing method of flushing
catheter lumens to create turbulence within the lumen.
•
A push-pause-push technique causes turbulence in the catheter
and flushes out blood and drug more effectively, thus preventing
blood or fibrin adherence to the lumen wall and tip.
•
Push-pauses are done in rapid succession, instilling 1 to 2 mL of
flush solution each time force is exerted with a push on the
syringe plunger ending with positive end pressure on the catheter
lumen.
•
Remove the syringe from the end cap and then close the clamp.
•
If your patient has a groshong-type PICC or a tunneled Groshong
CVC, use a rapid flush technique to open the valve.
31
CVC Caps - Access and Flushing
•
•
•
A positive pressure access system (e.g., Max
Clear, Flolink or PosiFlow) will be used for all
central lines (except CVP lines).
Before accessing, remember to use friction
and scrub the caps for a full 15 seconds with
alcohol and allow to dry.
The Bard Scrub Site IPA (isopropyl alcohol)
device is an alternative to using an alcohol
wipe to clean CVC caps (extraluminal and
intraluminal). Follow the manufacturer’s
instructions and precautions for use.
Hospital
Scrub the Hub
for 15 seconds
prior to each
access
Bard Scrub Site
32
Securement Devices for CVCs
•
•
•
•
•
Hospital
A securement device or catheter stabilization
device is an external apparatus to secure a
catheter (e.g. Stat Lock) and prevent catheter
movement or displacement.
A securement device is not applied to a
subclavian line or a PICC that is sutured in place
or with a tunneled central venous access device.
Monitor securement devices daily and replace
when clinically indicated, at least every 7 days and
with every dressing change.
Follow manufacturer’s recommendations for
application and removal.
If using a Stat Lock, the product must be loosened
with alcohol.
33
Aseptic Technique
Hospital
• To prevent contamination by microorganisms, use appropriate hand
hygiene, aseptic technique, sterile products, and gloves when
performing infusion related procedures, such as dressing changes
and implanted port access.
• Aseptic technique involves the use of added precautions, such as
use of sterile gloves, mask, or sterile supplies.
• Use Aseptic technique for all CVC dressing changes or port access.
• Use Aseptic technique when collecting blood samples to culture.
34
CVC Dressing Changes
Hospital
•Wear sterile gloves when changing
central line catheter dressings (CDC,
2011, p. 30) or when changing implanted
port needle and dressing.
•CVC dressing changes will be
completed using sterile supplies and
aseptic technique including wearing a
mask to reduce the transfer of
microorganisms.
•Place a mask on the patient if they
cannot turn their head away from the
dressing site.
35
Biopatch – Current Practice
•
Hospital
Tunneled CVCs such as
Hickman’s and Groshongs
now require a biopatch to
be applied to the exit site.
•
For long term Implanted ports a
biopatch is placed under the disk of the
huber needle.
• The dressing is effective for 7 days.
• A sterile transparent dressing is applied
covering the biopatch and the entire area
around the catheter.
• Change the biopatch whenever the
transparent dressing is changed.
36
Biopatch Dressing
•
•
•
•
Hospital
Blue side or grid side is visible (or up) when
applied.
The dressing must cover area around catheter;
slit edges are under catheter and should be
together.
The Biopatch must be in contact with skin and
covered with a transparent dressing.
Dressing and Biopatch are changed every 7
days or when soiled, wet, blood soaked or
loose.
• The biopatch can be pulled off while
removing the transparent dressing.
• If the dressing sticks to the site, use
alcohol to loosen.
37
Hospital
Blood Draws
Blood Draw from Lines
•
•
Hospital
Stop the IV solutions if the line is in
use.
Use the proximal lumen if the device
has more than one lumen (Perry &
Potter, Clinical Nursing Skills and
Techniques, 2010, p 777).
•
•
•
The discard amount prior to blood draw
from peripheral and central lines is 5
ml.
Flush with 10 ml preservative free
Normal Saline after a blood draw from
all central lines except an implanted
port.
Use a 10 ml or larger syringe for all IV
injections.
Flush with 20 mL preservative
free Normal Saline after a
blood draw from an implanted
port.
39
Establishing Patency – Huber needle
Hospital
• Wear mask and gloves and maintain aseptic technique
• The sterile gauze and alcohol prep are used for cleansing the
hub prior to attaching syringe
Click on image to view a brief video
40
Obtaining Lab Specimen – Huber Needle
Hospital
• Mask and gloves are worn.
• A sterile gauze and alcohol wipe is held near the hub.
• Wipe the hub prior to attaching sterile syringe.
Click on image to view a brief video
41
Blood Draw from Central Lines Continued
•
•
•
•
Vacutainer (to draw the sample
directly into lab tubes) is NOT to be
used with:
• PICC
• Midline
• Implanted Ports
If syringe is used, a blood transfer
device must be used to transfer the
blood into the lab tubes.
Fill evacuated laboratory tubes in the
“order of the draw” (e.g. blue top,
red/yellow top, green top, lavender
top) see policy Appendix A.
Label the tubes in the PRESENCE of
the patient.
Hospital
Vacutainer Device is not
to be used for PICC,
Midline and Implanted
Ports
42
Hospital
Key Points related to
CVCs
Key Points - Blood Cultures Drawn from a CVC
•
•
•
•
•
•
Scrub top of the blood cultures bottles with an alcohol pad
for 60 seconds, using 1 pad per bottle. Rest the alcohol pad
on top of the bottle to avoid airborne contamination.
Positive Pressure caps must be changed prior to drawing
blood cultures off a line.
Vigorously cleanse the Central line hub/cap with site
approved cleansing product for 15 seconds (e.g.
chlorhexidene swab). Allow hub to dry.
Discard 5 mls. Using new syringes, draw the blood samples.
A sterile angel wing blood transfer device with female
adaptor is used to transfer the sample from the syringe to
the blood culture bottles.
Fill aerobic bottle first.
Hospital
Blood culture bottles tops
prepped with alcohol
•
Label bottles in the presence of the patient.
• DO NOT COVER THE BARCODES ON THE BOTTLES
WITH THE LABEL.
(The policy contains the complete step by step procedure)
44
Angel wing device with female
adapter attached to a syringe.
Key Points – De-Clotting Central Lines
•
•
•
•
•
•
•
Hospital
Obtain MD order for Alteplase instillation.
Draw up 2 mL of 1 mg/mL reconstituted Alteplase (r-tPa) in a 10 ml
syringe.
Clamp the central line (if clamp is present), remove the end cap,
vigorously clean the hub and attach the Alteplase syringe to the
occluded catheter. Unclamp and gently instill. Clamp, then disconnect
the syringe.
Apply a new end cap.
Wait 30 minutes and then try to aspirate.
If no blood return, allow the Altepase to dwell for an additional 90
minutes (total dwell time of 120 minutes), then reattempt another
aspiration.
If no blood is aspirated, withdraw the first dose of Alteplase, then instill
a second dose of Alteplase. Repeat the steps. If unable to reestablish
catheter patency after the second dose of Alteplase, notify physician.
(See the policy for the complete step-by-step procedure.)
45
Hospital
Key Points - Discontinuing Non-tunneled CVC - Precautions
•
The risk of an air embolus increases when a
CVC is removed while the patient is sitting
upright due to increased intrathoracic pressure.
• Patient should be supine - NOT IN A SITTING
POSITION.
• Reposition the patient so the insertion site is at or
below the level of the heart to reduce the risk of air
embolism.
• If the patient can tolerate being repositioned, the
Trendelenburg position is preferred.
•
•
•
Instruct the patient to take in a deep breath and
then hold while withdrawing the catheter.
Occlusive dressing over the site must remain in
place for a minimum of 12 hours.
If you suspect that the catheter has been broken,
have patient lie still on left side and notify the
physician STAT.
If the patient is on a
ventilator, withdraw
the catheter during
the expiratory cycle
Trendelenburg is
preferred if the patient
can tolerate
46
Key Points - Guidelines for Patient Transfer
When the Patient has a CVC
•
•
•
Hospital
Upon transfer from another non-AHC facility, a
central line dressing change should be done
the day of transfer/admission to assess the
site.
If a central line was inserted without proper
asepsis or if it was placed at another facility
(non-AHC) without proper documentation, the
physician is notified to determine if the central
line requires replacement.
If the catheter is replaced, all fluids and tubing
are also replaced.
47
Damaged Central Line – Key Points
Hospital
•
If at any time catheter damage is suspected (tear, cut or puncture),
immediately apply a plastic toothless clamp close to body at the
exit site and proximal to the damaged area. This will help prevent an
air embolism.
•
Reposition the patient with their head below the level of the heart, if
tolerated.
• If the catheter is in an extremity put a tourniquet around the affected
limb proximal to the catheter insertion site.
• If catheter embolism is suspected, observe patient for cyanosis,
chest pain, hypotension, increased central venous pressure,
tachycardia, fainting, or loss of consciousness.
• Repairing of a damaged tunneled Central Line is no longer
recommended (this has been removed from the policy).
48
Hospital
Key Points - Hemodialysis Catheters Dressing Changes
• Mahurkar™ or Permcath™:
• All nurses are responsible for completing the dressing changes
on hemodialysis catheters.
• Use a Central Line Dressing kit and sterile gloves to change the
dressing.
• Use Biopatch under transparent dressing.
• Note new product - Hemodialysis Bard Catheter
• Use povidone iodine or dilute aqueoous sodium hypochloride
only.
• No ointments containing polyethylene glycol or alcohol; may use
bacitracin zinc.
• Only dialysis or pheresis trained nurses may flush a
hemodialysis catheter.
50
Hospital
Chapter III:
Lines Used for CT Scans
Hospital
CVC Implanted Ports for CT Contrast Injections
•
•
•
•
Only use a CT-Injectable implanted port for Power Injections.
Know how to differentiate these ports from standard implanted
ports.
Implanted ports that are not rated for CT contrast injections
may burst during the procedure due to the high pressures
generated.
Examples: PowerPort, Smart Port CT.
Smart Port CT
PowerPort
52
Implanted Ports - Power Injectable
•
•
•
PowerPort is indicated for
power injection (when used with
a PowerLoc™ safety infusion
set).
If the Powerport is being
accessed for a CT scan with
contrast, then the PowerLoc set
MUST be used.
• The Powerloc™ Safety
Infusion set also comes
with a sticker indicating its
Power Injection capability
and CT parameters.
Pressure extension tubing is
also available if added length is
needed for easier access during
radiology procedures.
Hospital
Above, Powerloc™ Safety
Infusion set for CT power
injection studies
•
When not being used for CT, the
Powerport can still be accessed
with a standard huber needle.
53
Hospital
PICCs Designed for Power Injection
Power PICC – (purple)
• Has clamps on lumens.
• Can be used for CT IV contrast.
•
Labeled as Power Picc.
Power PICC Solo – (purple/blue)
• NO Clamps.
• Can be used for CT IV contrast.
• Labeled as Power Picc Solo.
• Incompatible meds should be
separated by 10 ml normal saline
before and after medication.
Power PICC. Flush with
normal saline before and
after power injection
studies, followed by
heparin.
Power PICC Solo.
Flush with normal
saline before and
after power
injection studies.
54
Hospital
Chapter IV: TPN
TPN (Total Parenteral Nutrition)
Hospital
• All parenteral nutrition is filtered with a
0.22 micron filter.
• If a separate fat emulsion (Lipids) is
ordered, the fat emulsion is filtered with a
1.2 micron filter. The fat emulsion may be
piggybacked into the parenteral nutrition
below the 0.22 micron filter or infused
through a separate dedicated line.
• Change Parenteral Nutrition Tubing:
Baxter Clearlink 0.22
micron filter
• If TPN is only dextrose and amino acids, change
the tubing and filter every 96 hours.
• If TPN with lipid emulsions, 3-in-1 admixture,
change tubing and filter every 24 hours.
Baxter Clearlink 1.2
micron filter for lipids 56
TPN continued
Hospital
• No blood products, IV solutions, or meds should be
administered through the TPN line unless peripheral
access is impossible.
• Do not draw blood sample with TPN infusing unless
no other access is available. Note if drawing from a
line with TPN infusing, flush with 20 ml normal
saline before the draw.
57
Hospital
Chapter V: Miscellaneous
Need to Know
•
•
•
•
•
•
TKO Rate
Secondary IVs & Flush Bags
PICC line migration
Intraosseous Catheter
Patient Education
Topical Skin Refrigerant
Need to Know: TKO
•
Hospital
To Keep Open, Keep Open or Keep Vein Open
(TKO, KO or KVO) will be run at 10 mL per hour
unless otherwise specified in the order (Aurora
Health Care collaboration).
59
Need to Know: Secondary IVs
•
•
•
Hospital
Take into account secondary IV bag overfill and
add the extra volume when programming the pump,
do not administer by increasing the IV rate.
A minibag should not hang by itself as the primary
infusion.
See the policy for using a flush bag when the
circumstance exists for intermittent medications
without a primary IV ordered.
• Use a 250 mL NS as the primary bag.
• The volume to be infused is 30 mL.
• The rate is the same as the secondary
medication.
•
When both the primary and secondary are infused,
cap the IV.
•
Remember to change both the intermittently used
bag and tubing every 24 hours.
Primary Flush
bag must be
hung fully
extended from
hanger.
60
Need to Know: PICC Line Migration Outward Precautions
Hospital
•
While accessing a PICC line and/or when performing a PICC line
dressing change, the nurse should assess for any changes in the
external length of the catheter to determine if the catheter has
migrated.
•
If the catheter has pulled out from the insertion site, do not
attempt to push back in, or remove the catheter without notifying
the physician.
•
It is possible the PICC line can be exchanged without resticking
the patient.
No blood pressure measurement (can cause migration) or
venipuncture in the extremity with the PICC line.
•
61
Need to Know: Intraosseous Catheter
Hospital
**There is an entirely new section on IO catheters
in the policy**
•
IO catheters are usually placed in the proximal tibia
when there is an emergency need to establish
access.
•
Caregivers must have demonstrated competency to
insert IO needles.
•
IO catheter insertion sites are inspected for
infiltration every 8 hours.
•
Continued use of an Intraosseous catheter must be
evaluated by the provider after 24 hours.
The insertion site used
most frequently in
adults and children is
the proximal tibia (INS,
62
2011).
Need to Know: Patient Education
Hospital
• Patients may be sent home with
different instructions for care of a
tunneled catheter.
• Refer to FYWBs – e.g. Care After
Placement of Your Tunneled Catheter
x38157.
63
Need to Know: Topical Skin Refrigerant
Hospital
• Refer to Appendix B and C of the policy for methods
of topical anesthesia application for pain control
(saline, lidocaine, ice, etc.).
• Note that there is a new procedure for topical
anesthetic skin refrigerant.
• Topical Refrigerant KEY POINTS
•
•
•
•
MD order NOT required.
Wash selected site with soap and water; dry.
Disinfect the area.
Hold the container 3 to 7 inches away and spray
an area as big as a quarter until it turns white (4 to
10 seconds).
• Perform needle stick procedure within one minute.
• Advise patient thawing may cause discomfort.
Gebauer’s
Pain Ease
64