Focused Charting DAR note on IV patency

[Wrangler156]

Hey everyone once again :)

so I survived my first ever day of clinical yay! super excited! I have to write a DAR on my patient. Since my patient is in end of life care, the hospital doesn't keep a chart on him really, and he didn't really have anything to go on besides an IV that they just want to keep patent. So my instructor said it is ok to do it on the IV. this is what I have so far and I was wondering if a kind hearted soul would mind reading over it and see if I have left out anything? We have only been shown 1 DAR note and haven't ever really had one graded, but this one is worth 1/3 of my points for clinical day :/ nerve racking see how I haven't had any input from instructors!

D: Data A: Action R: Response

Focus: IV patency

D:Patient has IV catheter in left AC. Standing orders to flush IV catheter with 10 mL 0.9% normal saline. IV is 1/2 inch out of insertion site. -------------------------------

A: Notified RN of IV being 1/2 out of insertion site, RN states " since the patient is in hospice care, as long as the IV is patent we just leave them alone." IV site has mild swelling and erythematous. Flushed IV with 10 mL of 0.9% normal saline, normal saline was hard to push catheter was bent, but still patent. Notified RN of findings. RN stated that " as long as the IV catheter is patent we will leave it alone." ---------------

R: Patient tolerated procedure well, erythemia and mild swelling still present at insertion site. Patient denies any further needs at the time, bed in lowest position, call light within reach, all bed rails in up position, head of bed elevated at 30 degrees.

Sorry everyone have another question did I even use the words erythematous and erythemia correct? my understanding is that they mean redness. Also, should I put in the note that the NS was hard to push or is that not needed? I know we have been told to not chart to much. My instructor also said to put in the note what the nurse said so that is why that is in there. I am not sure the size of the IV it was not in the chart, and the nurse didn't know.

thanks in advance, once again I don't mean to sound like I am asking for all the answers, just guidance I am lacking the whole confidence thing

[hodgieRN]

In my opinion, yes, you can include that it was difficult to flush. That is one of the many describing factors when assessing patency. I am assuming that the RN felt that the redness and swelling was not related to the IV site. That can sometimes happen. If the IV was infiltrating, then you can get redness and swelling, but if the IV site is infected, it can do the same thing. The RN might have been strictly following comfort measures only protocol and didn't want to invoke pain with a new IV. If she said it was patent, then it was patent. If a pt is not comfort measures only (like a normal floor pt), then charting redness and swelling is grounds to D/c it and start a new one. But your pt was in hospice care at that point.

You would chart if the IV "flushed easy" or "difficult to flush", if it can draw blood, if there was any pain while flushing, or maybe leaking. Things like that...