IV site checks

Specialties NICU

Published

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......

Specializes in NICU, PICU, PACU.

My other question is..you aren't going to read the IV"s every hour? Now that is asking for big trouble...I have seen pumps set wrong or malfunction and the only reason it was caught was because the IV's are charted q1hr. Picc lines can infiltrate too, only into other parts of the body...I have seen a kid with a nice big chest due to fluids or a big shoulder. So, yes, even a PICC needs to be eyeballed. I also disagree with it is time consuming...it certainly doesn't take but a few seconds of your time to look at the site and the pump. Sorry, I'm just hearing warning bells going off at what your management is suggesting.

I have a friend that does legal and she said that your management needs to call other NICU's in your area and see what they are doing...that is where the standard of care for that area would stem...if you have a bad infiltrate, heck any infiltrate (that is what most people sue over) that is where the lawyers are going to look...at what other NICU's in your area do..then they will say that you are providing inferior care. Just food for thought.

How is your charting set up? We have a space for fluid amount in, site, which is a check with a circle around it for all is fine and then the pressure on the pump if applicable or if it is a syringe or baxter. Not time consuming at all.

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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.........

It happened at change of shift, that I checked the scalp IV with the nurse giving me report. He had documented putting in the IV just 20 minutes before. No reason for me to acuse him of lying he had it documented. Besides scalps have no where to hide the excess fluid.

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We do read the IVs every hour, when we visualize the site. We just don't palpate or flush every hour necessarily.

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Specializes in NICU.

We use armboards made of cardboard with a layer of foam, and a soft knit cover. We have them in two sizes, for premies and term babies. We also have Veniguards for dressings, and it is possible to tape without totally covering the fingers or feet. I like to see the site, and pink fingers and toes.

Are you always at your patients bedside, to check every hour? We leave for deliveries and c/s, and get new admits from those, leaving someone else to check the babies.

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Originally posted by Jolie

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.

Wow! thanks for the info. We never thought to consider armboards a restraint device.

We check out IVs Q2, but the babes on the floor with their mothers are saline locked, so they only get checked when flushed or receiving a med

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Specializes in NICU, PICU, PACU.

Are you sure that they consider an armboard a restraint? I have never heard that or seen that written anywhere! And believe me, we have the Nazi brigade working for us for accredidation!

Yes, if we can't read our own IV, the person sharing our room does for us and just signs their name beside it.

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You might check the Infusion Nursing Society standards of Practice.

http://www.ins1.org/index.html

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Specializes in Maternal - Child Health.

NICUGal,

My last JCAHO experience was right before I went out on maternity leave with my "baby" who is nearly 6, but I remember that distinction plain as day, because we had to scramble and update our flow sheets to accomodate hourly "restraint" checks for IV boards. It was ridiculous then, and still is now, as are most JCAHO requirements.

In my experience, JCAHO focuses on a few key items each year, and largely overlooks everything else. Old JCAHO standards rarely change; they stay on the books and fade into oblivion. So, while it is probably still the standard, it is unlikely that it would be closely examined unless it should become a "pet" issue again in the future. For example, minimizing use of physical restraints or protecting the integrity of IV sites.

If it's not on your flowsheet, I wouldn't sweat it!

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I too have seen some nasty infiltrations become visible in

On our daily flow sheet, there is a column to document the pump readings each hour. The next column has a place to put a check mark if site is clear. As long as I am documenting hourly pump readings, it is not much more trouble to check the next column also (after, of course, visualizing the site, comparing it to opposite side, if applicable, and further investigating any visible edema, redness, leakage, etc.etc.)

These little ones are SO prone to SO many horrible complications. I really feel that at least hourly (at the minimum) checks are necessary, Joint Commission or no.

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