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Vascular Access
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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

IVRUS's Latest Activity

  1. IVRUS

    PICC: aspirate blood before every infusion?

    So, let's say that you are giving an IVAB. Med is due at 0600. At 0555, you do all your checks on the IV catheter/drsg, you check the saline syringe, and you do a good, vigorous scrub of the needleless connector. You hook up your saline syringe, flush about two mLs, then slowly aspirate for a brisk blood return, the color and consistency of whole blood, then flush with the remaining 8 cc saline (if your policy is 10mL flush a and p) disconnect the saline syringe and scrub again vigorously with alcohol pad. Then administer the IV antibiotic over the needed time frame, stop when BAG IS EMPTY, then disconnect. Scrub connector again, then saline flush and Heparinize if needed, depending on the IV catheter. The only time to assess is blood return is at 0555. NOT at 0555, 0630, 0635 when the second saline is flushed.
  2. IVRUS

    sterile technique question for implanted port accessing

    That is why you are PALPATING initially with non-sterile gloves on, so that you only have to stabilize the port's body with one hand, while accessing it with the other hand. Yes, with sterile gloves on, you technically can touch the port, but I'd only stabilize the body. Why would you need to touch the septum after it was cleansed, when you already should have a good perspective of how the port lies under the skin?
  3. IVRUS

    Help! Struggling with IV placement in hand

    Well, Your process doesn't appear problematic, but how is your tourniquet placement? If you are placing the line on a geriatric pt, you may very well have difficulty being successful if you tourniquet is too tight. Elderly patients require loose tourniquet application, or you'll BLOW the vessel. In addition, choosing a metacarpal vein isn't always the best choice for this populi as they have lost a lot of SQ in the back of the hand with age. That SQ used to support the blood vessel, and without it, the vessel appears to be a road map on the back of their hand, but actually is a very fragile vessel. And, what gauge IV catheter's are you putting in. Remember INS standards say to choose the smallest gauge for the task at hand.
  4. IVRUS

    TPN infusing when to change PICC drsg?

    Any issues/complications, real or imagined, must come under the PRN dressing change tab. If you think you are seeing redness under at the site, that is a time when you MUST perform a sterile dressing change to assess and identify the next step in patient care. Our policy delineates dressing changes with a Transparent Sterile Membrane (TSM) covering the site to be performed q 7days and PRN!!
  5. IVRUS

    PICC dressing change with 3M Tegaderm with CHG

    https://multimedia.3m.com/mws/media/993615O/picc-cvc-chg-device-application-guide.pdf Maybe their website instructions can help
  6. IVRUS

    Best practice for locking a central line with heparin.

    Kristine, What is the concentration that you are using to "lock" the PICC line? Standards, and many Policies have you locking catheters with the lowest concentration, namely 10 units/mL. With this concentration, there is no need to withdraw the heparin that was dwelling in the catheter lumen prior to flushing. Withdrawing prior to flushing is mandatory, however, on Dialysis Catheters as the concentration used is much greater.
  7. First of all Karen, this conclusion, imo, is nonsensical. Yes, having a central line in increases the chance of large vessel thrombosis, but the benefit of having it is so much better than the inherent risk. Bloodstream infections can occur with all types of IV catheters especially if ANTT is not followed. Pneumothorax is a concern only upon catheter placement, and arterial injury??? I've seen unskilled MD's attempt vascular line placement and go intra-arterial instead of in the vein, but again, those are unskilled physicians. Also, greater than 1 out of 10 had issues... that is unacceptable. And, it says the risk may be overstated and unfounded. The osmolarity of 3% Sodium Chloride is > 1,000. Anything over 900, has a much greater probability of causing serious harm to the smaller blood vessels in the arms. Circulation/blood flow is nowhere near what it is in the central venous system. Disagree with this "study". However, as said in my earlier post, I would much rather see this infused via SPC, than a Midline, and that was really what my comment was about.
  8. IVRUS

    CLABSI - Multiple lumens vs Y sites

    Standard 36 specifically addresses add-ons and it states, " When indicated, preferentially use systems that minimize manipulation and reduce components, such as integrated extension sets" Therefore, it is saying, that if at all possible, don't use add-ons as they greatly contribute to bacterial introduction. And, yes, 2016 is that last one. They update standards every 5 years.
  9. IVRUS

    Tricky portocath

    IMPLANTED PORTS are sutured into a subcutaneous pocket. If these sutures broke, the port will travel under the skin and be hard to pin down. The MD should go in and fix this problem. Now lack of blood return could mean that the IV catheter has been severed from the ports body. This given the situation, would not be uncommon. Do not use this port. It must be surgically fixed. The lack of blood return also could be from fibrin buildup, so just how recently was it placed, and is the patient hypercoagulable?
  10. IVRUS

    Flo Valley Fall 2015

    I don't know who you are, or what the issue is, but if you read the first two posts, this person seemingly was frustrated because over several days without a response to her OP, she came back. So, it needed to be pointed out that in order to get the responses she/he desired, then specifics were needed. How is that problematic? Arrogance is not the issue here. It is however, problematic when one merely imparts information and he/she gets slammed for it.. "Indeed, no good deed goes unpunished."
  11. IVRUS

    Flo Valley Fall 2015

    Wow, burning bridges already and you're not even a Nursing student yet!! Smh
  12. IVRUS

    New to Infusion

    I'd start by joining your local chapter of Infusion Nurses Society (INS). Getting involved with IV therapy and having fellow nurses to network and assist you in your journey is important. Go to their website and find your local chapter. www.ins1.org
  13. IVRUS

    IV Vaso-Vagal HELP

    Please remember that Vasovagal reaction is manifested by VASOCONSTRICTION. Your entire peripheral system shunts blood to the vital organs, as you are likely to faint. When vessels constrict, short of time and warm compresses, US will help greatly getting to those deeper vessels for cannulation.
  14. IVRUS

    Removing the PICC line where there is a DVT?

    As long as you have a PICC that ONLY has involvement with a Thrombus, then research shows that it is important to savage it and lyse the clot with a 4-6 hr infusion. But, if it is thrombosed and infected, it must be removed.
  15. IVRUS

    Dual Lumen Midlines and Drug Compatibility

    Mikey, We know that you don't have the blood flow in your arms versus the central vascular system. Therefore, IMO, it is NOT wise to give two incompatible medications at the same time into an IV catheter which does NOT have the needed blood flow to dissipate the medications. Studies regarding this aren't available to my knowledge, so I would just say NO.
  16. IVRUS

    Flagyl compatibility with D51/2NS

    It can be confusing, but Gahart's guide to IV medications state that Flagyl is compatible with NS, D5W and LR.