IV policies

i need some help! we are currently reviewing our iv policies and procedures. can you tell me what you do at your hospital for the following:

**how much ns is used to flush central lines? how much heparin is used?

**what is your iv rotation policy?(how many days)

**do you use an iv start kit?

**is chlorhexadine used to prep the site?

**what type of dressing do you use for peripheral iv lines? central lines?

**do you know where i could get pictures of infiltrates do show the difference between the different grades?

**how are infiltrates treated? would you share your policy?

thank you so much for any information you can share with me.

1- only ns and 10cc with a turbalent method. no heparin allowed unless ordered

2-every 72 hours

3-i always use an iv start kit, policy yes too yet???

4-depends on the nurse and unit,

5-clear one that comes in iv prep kit or a clear tegaderm usually from piccline or central dressing kit

6- not sure ask the iv therapy team if you have access to them

7- d/c iv asap, document s/s, c/o and interventions used and apply warm compress and restart in another site

I need some help! We are currently reviewing our IV policies and procedures. Can you tell me what you do at your hospital for the following:

**how much NS is used to flush central lines? how much heparin is used?

**What is your IV rotation policy?(how many days)

**Do you use an IV start kit?

**Is chlorhexadine used to prep the site?

**what type of dressing do you use for peripheral IV Lines? central lines?

**Do you know where I could get pictures of infiltrates do show the difference between the different grades?

**How are infiltrates treated? would you share your policy?

Thank you so much for any information you can share with me.

1) ONLY NS!! We use 10cc for a routine flush, 20cc after a blood draw.

2) Change sites every 4 days (96 hours). We just changed this year from 72h - it was investigated by our Infectious Disease department after we came to them with the fact that many facilities were changing to this. Recent studies have shown that every 96 hours is safe and (obviously) leaves the patient with less tissue trauma.

3) No, too pricey for us. We (the IV nurses) either wear an apron with our supplies in it or carry a plastic tray.

4) Yes, we use chlorhexadine - if you are in the position to, lobby for the swabsticks - softer for patient's skin and you can easily clean a large area. We use the larger (3cc?) sponges for cleaning PICCs and CVLs.

5) No, I don't have any... I could show them some in real life though!

6) I depends on the med/fluid and the degree - whether it is truly just an infiltrate or a phlebitis. Sometimes heat and definitely watch it.

Please comment on this IV situation in our hospital.

1. If an inpatient comes to our imaging dept. on a intravenous pump, then we are to re-stick a new venous site instead of using the access provided.

What are current policies on unhooking IV pumps and allowing for contrast media injection through the current site.

2. So many of our patients have a limited number or no IV sites already, and it does not seem ethical to subject some of these critically ill patients to another stick just for the injection of a IV contast media.

3. Please comment on the use of a varied number of technologist, not all registered, on actually suspending the pump and restarting- I am worried about the "button pushers" and incorrect pump restarts.

4. For the safety of the patient, could we not disconnect the patient from the pump for a 60 second IV contrast injection, cap the IV with a blunt cannula tip, allow the pump to keep dripping without interrupting the pump settings, flush the IV site with normal saline after the injection, and then finally reconnect the IV site to the pump.

Please advice on this situation. We need help.

Please comment on this IV situation in our hospital.

1. If an inpatient comes to our imaging dept. on a intravenous pump, then we are to re-stick a new venous site instead of using the access provided.

What are current policies on unhooking IV pumps and allowing for contrast media injection through the current site.

2. So many of our patients have a limited number or no IV sites already, and it does not seem ethical to subject some of these critically ill patients to another stick just for the injection of a IV contast media.

3. Please comment on the use of a varied number of technologist, not all registered, on actually suspending the pump and restarting- I am worried about the "button pushers" and incorrect pump restarts.

4. For the safety of the patient, could we not disconnect the patient from the pump for a 60 second IV contrast injection, cap the IV with a blunt cannula tip, allow the pump to keep dripping without interrupting the pump settings, flush the IV site with normal saline after the injection, and then finally reconnect the IV site to the pump.

Please advice on this situation. We need help.

Our radiology department will use an existing IV for contrast depending on the type of exam being done. If they need to use their power injector they need an AC line, but they will use an existing one if the pt has one. They call the floor to check on what the pt has for access before sending for them, and the floor RN will call the IV nurse if the pt needs a different site. In Oregon it has to be a RN starting the IV.

I think that what usually happens with infusion pumps is that they are turned off and the tubing is disconnected for the site to be used by someone in radiology, and left unhooked until the patient is returned to the floor, unless the patient needs to be hooked back up right away and then a RN is called (either rad RN, IV RN or floor RN). I think any patients that come from ICU/CCU have an RN with them, but I work in IV not Rad so I don't know for sure.

Our radiology department will use an existing IV for contrast depending on the type of exam being done. If they need to use their power injector they need an AC line, but they will use an existing one if the pt has one. They call the floor to check on what the pt has for access before sending for them, and the floor RN will call the IV nurse if the pt needs a different site. In Oregon it has to be a RN starting the IV.

I think that what usually happens with infusion pumps is that they are turned off and the tubing is disconnected for the site to be used by someone in radiology, and left unhooked until the patient is returned to the floor, unless the patient needs to be hooked back up right away and then a RN is called (either rad RN, IV RN or floor RN). I think any patients that come from ICU/CCU have an RN with them, but I work in IV not Rad so I don't know for sure.

Thank you so much, I will return to work tomorrow with this stragedy. I hope we can implement for the patients' sake.

The Intravenous Nurses Society publishes the Standards of Practice of IV therapy. These set the bar for all IV therapy practice. A good place to start! You can order from the web site: http://www.ins1.org

I have seen an RN use a portion of a 10ml NS flush prior to IVP, recap, give med, then use the rest of the 10ml flush after the med. Is this kosher? I thought once used it was considered contaminated...she is proud of her cost effectiveness. What's your thought(s)?

Pre-filled NS syringes are intend for single patient/single use not multiple use on a singles patient. She might think she is saving money and she may well be until the patient gets a Catheter related blood stream infection which in turn could cost $ by treating said infection, increased length of stay etc.

Can a registered nurse administer IV contrast in radiology department. In our hospital the nursing incharge claims that it is the duty of X-ray technicians and RNs will not administer IV contrast. Is there any guidelines by any renowned nursing body regarding the issue of administering IV contrast

Regards

NisarAhmed

We were told that prefilled flushes are good for 1hr after opening by our pharm. Do you think that there is something wrong with what I am doing in this instance?

Pt has a saline lock in place with no fluids running and needs an IVP med, ie, 1mg morphine... I would open a new prefilled 10ml flush, unlock the slide clamp on the t- connector tubing, flush with a few mls to ensure patency of the site, give the med, then flush with the remaining amt of saline. Of course, wiping the claves with alcohol each time.