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Important Phone Numbers. When should you call for help? Where can you learn more? Top of the page. Your Care Instructions Medicines or fluids may be given through an intravenous IV tube inserted into a vein. How can you care for yourself at home? Check the area for bruising or swelling for a few days after you get home. If you have bruising or swelling, put ice or a cold pack on the area for 10 to 20 minutes at a time.
Put a thin cloth between the ice and your skin. Shower or bathe as usual. Infiltration : occurs when drugs or fluid infiltrates into the tissue surrounding the venipuncture site. This happens when the tip of catheter slips out of the vein, catheter passes through the wall of the vein, or as blood vessel wall stretches which allows fluid to infuse into the surrounding tissue.
Phlebitis : a sign of vessel damage. The cause can be chemical due to the osmolarity of the solution , mechanical from trauma at insertion or movement or infective microorganisms contaminating the device. Signs include swelling, redness, heat, induration, purulence, a palpable venous cord hard vein and pain related to local inflammation of the vein at or near the insertion site.
Double checking: refers to the practice of two clinicians appropriately endorsed Enrolled nurses EN , Registered Nurses RN , Doctors or Pharmacists independently checking the medications.
Assessment Patient and IV site assessments should be done on a regular basis. PIVC are considered as high risk for pressure injury. PIVC sites should be checked hourly for pressure sore and any signs of infection unless documented otherwise. Check splint tapes are not too tight or restrictive. Assessment of IV lines, equipment and IV fluid infusions: If the patient is receiving continuous IV fluid infusion- observations of the IV site, type of fluid and volume infused, accurate rate of infusion for patient and pressure alarms of infusion pumps are observed hourly and documented in the fluid balance flowsheet.
If the patient inpatient setting is having intermittent infusion, eight hourly assessments are a minimum. Unstable patients who have signs and symptoms of complications are to be assessed more frequently.
If the patient no longer requires IV access for infusions, remove the cannula at the earliest to avoid complications. Caregiver and patient education will be provided on the signs of injuries and the process of contacting the nurse. Management Administration of intravenous fluid, drug infusions or blood products a Continuous infusion of IV fluids Assessment and documentation of findings are to be completed hourly to determine effective delivery of prescribed medications and fluid.
Each bag of fluid is independently double checked and a signed patient label is put on the bag. Check the solution is the prescribed one, the rate of infusion, and the amount infused is noted. Upper limit infusion pump pressure can be manually increased with clinical discretion to accommodate: Increased viscosity of the fluid being administered High rate of the fluid being administered Reduced diameter of the intravascular catheter Increased length of the intravascular catheter Increased level of patient activity If pump pressure exceeds the recommended limits, check the patency of the PIVC.
Drugs administered via: Burette of an infusion set: to dilute the drug in a smaller volume via burette giving system, hang the bag of infusion fluid and gradually open the roller camp to allow appropriate amount of diluent into the burette. Inject the prescribed drug into the burette via the additive port. Syringe driver: is recommended for children weighing less than 10 kg.
Draw up required volume of diluent in appropriate size syringe and then pull back the syringe plunger to enable you to inject the drug into the syringe using aseptic technique. Infusion bag: Clean the access port with disinfectant swab before injecting prepared drug into infusion fluid bag via the additive port. Without contaminating the key part spike insert the spike on the administration set into the septum of the infusion bag.
Access PIVC only after cleaning the access port and scrub the hub. Administer blood product transfusions via a volumetric infusion pump or syringe driver to ensure accurate delivery. Use gravity sets only when rapid administration is required with diligent monitoring of volume.
Use a Neonatal transfusion set includes a to micron filter required for blood products and syringe driver for delivering small volumes of blood products. Using aseptic non touch technique, spike the blood product septum with the Neonatal transfusion set and attach an appropriate sized syringe for the transfusion to the 3 way tap.
Draw the required volume into the syringe and prime the rest of the neonatal transfusion set. Label the syringe with both patient and blood product identification details including expiry date and time of blood product.
If rapid transfusion of small volumes is required, draw the required volume into a syringe through a to micron filter. Burettes should not be used for transfusion of blood products. Sterile 0. This must be prescribed as a medication. The optimal volume used for intermittent injections or infusions is unclear. The literature suggests the volume of flush should equal at least twice the volume of the catheter and add on devices and a minimum of 2mL normal saline flush is recommended.
Use 10ml syringe for flushing to avoid excessive pressure and catheter rupture. Syringes with an internal diameter smaller than that of a 10mL syringe can produce higher pressure in the lumen and rupture the catheter.
If resistance is felt during flushing and force is applied this may result in extravasation Use aseptic non touch techniques including cleaning the access port scrub the hub with a dual disinfectant agent e. Flush in a pulsatile push-pause motion. Flush catheters: Immediately after placement Prior to and after fluid infusion as an empty fluid container lacks infusion pressure and will allow blood reflux into the catheter lumen from normal venous pressure or injection.
Prior to and after blood drawing. The dressing must be kept secure, clean dry and intact. Indications for dressing change: when it becomes insecure or if there is blood or fluid leakage under the dressing. Determine the need for an assistant considering patient age, developmental level and family participation prior to the procedure. If patient is allergic to transparent film dressings, use sterile film dressing to be used and changed daily.
Carefully remove the old dressing, holding the cannula in place at all times Take the opportunity to thoroughly inspect the site of entry of the cannula for any sign of infection. Cleanse the area around the catheter insertion site including under the hub using a pattern which will ensure entire area is covered. Allow skin preparation to air dry prior to applying any dressing, this allows the disinfectant to work.
Consider placing a small piece of sterile cotton wool ball or gauze underneath the hub of the cannula to reduce pressure. If desired, place sterile tape over the hub of the device before placing the transparent dressing. Cover the cannula insertion site with sterile transparent semipermeable, occlusive dressing e.
Tegadermtm, IV tm placed using an aseptic non touch technique over the catheter. This will allow continuous observation of the site and to help stabilise and secure the catheter. This will adequately immobilize the joint and minimise the risk of venous damage resulting from flexion.
When using Splints, ensure these are positioned and strapped with the limb and digits in a neutral position to prevent injury from restricting blood or nerve supply and to prevent pressure sores Inspect the splint at least daily and change if soiled by blood or fluid leakage.
Cover with non-compression tubular bandage. Based on the results of this large well conducted multi-center trial, you can now respond to the nurses question with an evidence-based response.
There is no need to change PIVs every hours. Instead, symptom triggered removal and replacement, based on phlebitis, pain or malfunction are better triggers for changing PIVs. These results are in line with the major change in central venous catheters insertion and removal that resulted from a major study in the NEJM 20 years ago as well as several smaller studies in children.
In addition to saving potential pain and suffering associated with repeated attempts at PIV insertion, this study suggests that adopting an as needed approach to changing PIVs may save healthcare dollars as well as nursing and physician time.
In addition, hospitals should consider revising their guidelines regarding the duration PIVs can stay in place. Rickard CM et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial.
Lancet Sep 22; Get our weekly email update , and explore our library of practice updates and review articles. PulmCCM is an independent publication not affiliated with or endorsed by any organization, society or journal referenced on the website.
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