IV site checks

[cindylouwho]

can anyone out there tell me how often they check their IV sites on the Nicu babes?.....we are in the process of trying to change ours from every hour to something less often....of course that doesn't include the check you do when you give a med or are in the bed doing vitals or just walking by.......how often do you think it needs to be documented?....thanks for your responses......

[Jolie, BSN]

I've never worked in a unit where IV site checks were documented less frequently than q1h. Does JCAHO still require q1h checks on restraints? If so, then you might as well keep the IV checks hourly, because they consider IV boards to be restraints.

[cindylouwho]

we don't use IV boards that often....hardly ever

[cindylouwho]

what do you consider a check.....flush?....touching the site?..visualizing the site?....or just looking through the isolette?

[dawngloves, BSN, RN]

I at least visualize the site qh. Depending on where it is I observe the area for redness, swelling, leaking or blood. If it is in the foot or hand I look at the nailbeds. If there is any question in my mind I will palpate the site and/or flush it.

[NicuGal, MSN, RN]

I believe it is standard of care nationally to check the site q1hr. I've seen some nasty IV infiltrates that have happened in an hour, esp with vasopressors and bicarb. IMHO...not a good idea to spread out the checks, if it ever went to court they would look at what most units do nationally.

We actually touch and look at the site...it doesn't take but a few seconds.

[wjf00]

I believe an infusing IV should be looked at hourly at a minimum. Why would you consider less often? I have seen a site blow up the size of a golf ball in 20 minutes.

[Mimi2RN, ASN, RN]

Originally posted by cindylouwho

we don't use IV boards that often....hardly ever

How do you protect your IV sites? I realize your patient are probably a lot small than ours, (> 28 wks)but parents are frequently part of the problem when we lose our IV's.

[NICU_Nurse, BSN, RN]

Ditto what Nicugal said- I've seen horrible, blistering infiltrations as well as osteo and one horrible, sad case of amputation secondary to infiltration. I've seen babies cry all night long for "no apparent reason" and then in the morning the nurse realizes the IV was slowly infiltrating over twelve hours. Not worth it to me; I check every hour with a quick peek-and-touch.

We do computer charting, and our system allows us to chart this all at once, so it doesn't hinder us in any way (though, even with this easy system, people still don't always check).

I, personally, HATE armboards and try to stay away from them- the traditional kind, at least. We have the old fashioned kind- the vinyl covered ones with the metal piece inside, wrapped in foam? HATE 'EM. I will use any combo of folded gauze or cotton balls and tape very sparingly- it's one of my peeves, I guess, to come on and find this poor baby taped to high heaven, circulation all cut off, and can't visualize the limb or site unless you take it off. When you do, whoops, there's a huge infiltration nobody noticed. Grr. The armboards aren't flexible enough for me, I guess...I like to custom make my apparati. (Is that a word? LOL!)

[cindylouwho]

thanks everyone for all the input.....now I'm wondering why my supervisor is even giving us the option of changing since it seems to be standard protocol...however I will say this.....I don't know why but I am not seeing the infiltrates that you all describe in our unit...perhaps due to the fact that we have PICC lines on any small babies and the larger babies don't hang on to their IVs that long.....we have a set of doctors that believe in getting rid of those as quickly as possible........I guess we do all check more often than I realize...it was just the hourly documentation that get's time consuming.....and I have to agree with some of you....not everyone checks them hourly....I guess that's why the question of if it's needed or not......and I've never seen an IV balloon to the size of a golf ball in 20 minutes....if it did...it wasn't in the last hour check that was made either.........thanks to all and I will appreciate more input if there is any....

[cindylouwho]

we all feel that the site can be better visualized without an armboard .....we haven't had better luck making them last with an armboard so we only use them occasionally.....I personally can tell a lot easier if I don't have an armboard in the way

[fergus51]

We do a look every hour, but not necessarily a touch and flush. It depends on what solution is infusing. If you are running something caustic like bicarb, that's one thing... If you're running plain NS or D5W at 1cc/hr, then that's another and you don't need to be in there all the time.