IV therapy

[IBVicki]

I'm preparing to teach an IV therapy class and need your help. Are you using mini-infusers or armboards in your practice? If so, where? Acute care, extended care, clinic...? Also, are you using separate filters for TPN, lipids, and blood products or are they all packaged together and/or inline? Are pall filters still being used? I would love to hear from as many people and sub specialties of nursing as possible. Thanks.

[Asystole RN]

This is exciting news, IV therapy is definitely an area where education is needed.

For my line of work I travel pretty much every week to a new hospital across the country.

The types of products used and practices tends to be highly regionally based. I would recommend reaching out to one or two of your local hospitals or your local INS chapter to identify specific equipment and practices that are pertinent to your AO.

[Sunflowerinsc, ADN, RN]

Arm board, haven't seen one for years and years!

[iluvivt, BSN, RN]

Who are you teaching this class for? Is this for a specific hospital or community based class? If you can answer those I can be more specific in my response.

Blood filters: Standard blood filters range from 170 to 260 microns and are an integral component of blood tubing. They serve to retrieve clots and other cellular debris from reaching the patient.

Microaggrgate filters: Range from 20 to 40 microns. These should be used when whole blood or packed cells have been stored for 5 days or more and in cardiopulmonary bypass surgery. These filters trap non-blood component particulate matter and harmful microaggregates. You also see them used when multiple units are being given. Pall is a brand name as many companies make blood filters so best to use generic terms when teaching. It would be great if you have samples to show.

Leukocyte reduction filters: These are only used on RBCS and platelets and serve to remove approximately 99 percent of leukocytes. Leukocyte reduction is also done in the blood bank. These filters can be difficult to prime. Tell them WHY they are needed. Why is it necessary to remove the Leukocytes?

TPN: Must be filtered using a .22 micron filter. This can be an integral part of the tubing or can be an add on filter. (ADD at the most distal part of the tubing) Lipids will eventually clog a .22 micron filter so you must piggyback this in at the Y site on the filter or at another distal site past the filter (at a dual micro add on set). If you are administering a 3 in 1 TPN solution you need to use no smaller than a 1.2 micron filter (lipids do not clog this filter).

Is there anything else I can help you with?

[IBVicki]

Thank you. It's a class for nursin students. My only other question is about mini-infusers and armboards.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I work ED,..we don't use mini infusers, the only time I use arm boards are on pediatric patients.

[A~L~B]

I use arm boards on most of my picu patients. I use pall filters in my congenital cardiac patients. At one of my hospitals they filters come packaged in line on the regular tubing and the other they are in line on the micro tubing for syringe pumps. The micro tubing at one hospital we add the pall filter for the congenital cardiac patients.

[Julius Seizure]

I'm pretty sure we use .22 micron filters on our cardiac kids, not the larger size filter.

[iluvivt, BSN, RN]

Tpn is not the only reason one must use a filter. If a manufacturer recommends a filter,you should use one. Dilantin if given in a mini bag should be filtered.

Arm boards are still used in the pediatric setting. Once a child can cooperate I cease to use them. In the adult setting they are not used as often. They should optimally be used if the IV must be placed at at a area of flexion. This is to minimize the risk of phlebitis mainly and also leaking from the insertion site and overall dwell time. It is best to avoid an area of flexion but if you must do it then you must and then take the next appropriate action based upon your assessment. If you have an IV team that may be requesting an IV consult so the IV nurse can assess the veins to see if they can sustain the prescribed IV therapy.

There are many types of infusers.Are you referring to a syringe pump, if so they are still in use. Make sure you include the use of smart pumps and why it is essential to not bypass the safeguards that they provide. Anything else? INS just published their new standards. You need to purchase these and look them over as these new nurses will be held to the standards of care and their policies which hopefully are up to date!