Iv therapy




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IV THERAPY





GBMC does not have an IV therapy team. It is the expectation of all nurses that they will start peripheral IV’s as well as have the knowledge to care for central venous access.



  • All IV sites are to be changed every 72 hours. If the IV cannot be changed, a physician order must be obtained to leave the IV in place another 24 hours. This order must be obtained daily.

  • All IV tubing must be changed every 72 hours.

  • All IV bags must be changed at least every 24 hours.

  • Adult KVO rates are 30-50cc/hr unless otherwise ordered by the physician, or as dictated by patient diagnosis.

  • Peripheral medicine locks are flushed with 1cc of Normal Saline every 8 hours.

  • Central lines are flushed every 12 hours with the appropriate flush, as outlined in the attached Central Line policy/chart.

  • For all inpatient areas, IV assessments, starts, and discontinues are documented on the IV assess / invasive line status intervention in Meditech.

  • For all inpatient areas, all IV fluid volume documentation is entered on the IV Intake Spreadsheet in Meditech.





 

GBMC


CLINICAL POLICY AND PROCEDURE MANUAL

SURGICAL SERVICES



CENTRAL VENOUS ACCESS DEVICE

Approval:

Signature on file:

V. P. Nursing, CNE
I. PURPOSE

To provide guidelines for the care of the patient with a central venous access device.



  1. POLICY

Types of devices most commonly used at GBMC

  1. Non tunneled device—Arrow Triple Lumen Catheter (TLC), Peripherally Inserted Central Catheter (PICC), Power PICC** and Power TLC**

  2. Tunneled device—Hickman catheter and the Groshong catheter, and Power Hickman**

  3. Implanted device—Port-a-cath, R-port and Power port** (power port must be accessed with power needle for CT scans)

  4. Vascular Sheaths—used in the insertion of Temporary Pacemakers and Pulmonary Artery Catheters (Critical Care only)

  5. Hemodialysis Access devices—cared for and flushed by the Hemodialysis Nurses.

  6. **Power venous access devices are used with the power injector needed for CT scans. They are purple in color and are cared for the same as their non-power counterpart.

All fluids running through a central venous access device must be on an infusion pump.

Registered Nurses and Licensed Practical Nurses who have shown competency through the orientation process can draw blood from, flush, dress, access or attach fluids to a central venous access device.

Anti-reflux valves must be on the ports of all lines or on the port of the needle for implanted devices. These valves should be changed every 72 hours at the time the IV tubing is changed.

MICU, SICU, CCU and Emergency Department nurses may discontinue

a Triple Lumen Catheter or venous vascular sheath with a physician order—Follow procedure in AACN Procedure Manual for Critical Care page 498-501.

Upon receipt of a physician order, Registered nurses in the following department/job category may treat thrombo-occlusions of central lines with t-Pa: MICU, SICU, CCU, Emergency Department, U38, U34, Interventional Radiology, Infusion Therapy, Educators/Clinical Specialists/Nurse Education Specialist. (See Critical Care policy—Declotting Central Venous Access Devices)

Dressings on all central venous access devices are to be changed every 7 days with the application of Biopatch supplied in the Central line Dressing Kit and the Port Access Kit. Date, time and initial all central line dressings. Include date of insertion and date of dressing change.

Non-coring needles (Huber) are changed every 7 days.

Fluids must be changed every 24 hours and tubing every 72 hours per GBMC Intravenous therapy policy.


  1. CENTRAL LINE PROCEDURES: Follow procedures in Clinical Nursing Skills and Techniques by Perry and Potter, Chapter 19 pages 604-613 with these exceptions.

    1. Dressing Change-use Central Line Dressing Kits

        1. Use Chloroprep supplied in kit in place of alcohol and providone-iodine

        2. Do not use gauze to cover insertion site

        3. Use BioPatch dressing over insertion site and under transparent dressing.

    2. Flushing-follow guidelines on Central Catheter Chart (Appendix A)




ORIGINAL: 7/88
REVIEWED: 3/90, 11/91, 1/93, 11/95, 10/98, 02/03


REVISED: 12/90, 10/93, 03/04, 04/06, 12/06

Appendix A
All catheters should be flushed according to manufacturers guidelines. The following is a chart containing those catheters most frequently used at GBMC.


Implanted Devices


NAME OF

CENTRAL CATHETER

BRAND NAME OF CATHETER

VOLUME OF FLUSH

FREQUENCY OF FLUSH

INDICATIONS

FOR USE

R-Port

Peripheral Infusion

Device


Medi-Tech

1. Normal Saline 10 cc

Heparin

5 cc of 100 units/cc
2. Normal Saline -20 cc

Heparin

5 cc of 100 units/cc
3. Normal Saline-10 cc

Heparin

5 cc of 100 units/cc

1. After each medication and blood draw--use pulsatile (start/stop) flush technique.

2. After each blood sampling or infusion.

3. Every 4 weeks if not being utilized.


The R-port is implanted peripherally under the skin in the non-dominant arm and is used for long-term access. All types of fluids and medications may be infused. May be used for blood sampling. May be used with gravity infusion or pumping device. Use only a Huber non-coring needled for accessing or heparinizing the catheter. Use only a #20 gauge or #22 gauge 1/2-3/4 inch needle.

Do not allow blood pressures to be taken or blood to be drawn from the arm with the port except through the port.

For care of the fresh post0op insertion—follow physician orders


Implantable

Infusion Port



Port-A-Cath

Mediport


Infuse-A-Port

Power Port


1. Normal Saline 10cc

Heparin

5cc of 10units/cc


2. Normal Saline 10cc



Heparin

5cc of 100units/cc

1. After each medication and blood draw.

2. Every 4 weeks if not being utilized



The port is implanted under the skin in a subcutaneous pocket of the upper chest and is used for long-term access. All types of fluids and medications may be infused. May be used for blood sampling. Use only a Huber non-coring needled for accessing or heparinizing the catheter.
For care of the fresh post-op insertion—follow physician orders



Central Catheters





NAME OF

CENTRAL CATHETER

BRAND NAME

OF CATHETER

VOLUME OF

FLUSH

FREQUENCY OF

FLUSH

INDICATIONS

FOR USE

Triple Lumen

Arrow Edwards Abbott

Power TLC


Normal Saline 5cc in each lumen
Heparin

1cc of 10units/cc in each lumen

1. After each medication administration.

2. Every 12 hours if not being used for infusion.



Three types of IV solutions can be given simultaneously without mixing. Can be used for blood sampling. Short-term catheter.

Single Lumen

Arrow Cardiosearch

Normal Saline -5cc

Heparin

1cc of 10units/cc

Every 12 hours if not being used for infusions.

Single IV therapy

Short-term catheter.



Peripherally Inserted Central Catheter (PICC)

Bard

Power PICC


Normal Saline -5cc in each lumen

Heparin
2cc of 100units/cc in each lumen

1. Every 12 hours if not being used.

2. After each medication administration or blood draw.



Usually used for therapy that is less than 6 months in duration.



Tunneled Catheters


NAME OF

CENTRAL CATHETER

BRAND NAME

OF CATHETER

VOLUME OF

FLUSH

FREQUENCY OF

FLUSH

INDICATIONS

FOR USE

Cuffed Tunnel

Central Catheter



Hickman Broviac

He Med


Power Hickman

Normal Saline -5cc each lumen

Heparin
5cc of 10units/cc


Heparin
5cc of 100units/cc

1. Every 12 hours if lumen not being used for infusions.

2. After each medication administration or blood draw.

3. At the end of therapy


Long-term catheter for drug and fluid administration. Available in single or double lumen

Groshong Single Lumen Dual Lumen

Groshong

Normal Saline – 5cc Flush vigorously

1. After each medication and/or solution administration.

2. Once every 7 days when not being used for medications and/or solution administration.



Intended for long-term central venous access in adults and children. A two-way valve is located adjacent to the closed distal tip of the catheter, which remains closed when not in use. The valve eliminates the need for clamping of the catheter. Do not clamp the catheter.

Groshong (cont)




Normal Saline – 20cc Flush vigorously.

1. After blood sample withdrawal.

2. After blood transfusions.

3. After infusion of blood products.


Infusion of highly viscous fluids is accomplished with slight pressure causing valve to open outwards. Simple syringe aspiration creates a negative pressure causing the valve to open inwards to achieve blood withdrawal.

Groshong (cont)




Normal Saline30 cc Flush vigorously

1. If blood is observed in the catheter.

2. Prior to blood sampling after infusion of TPN solutions.



NOTE: When irrigating catheter after blood sampling, remove injection cap and connect directly to catheter connector.





Hemodialysis Catheters







NAME OF

CENTRAL CATHETER



BRAND NAME

OF CATHETER



VOLUME OF

FLUSH



FREQUENCY OF

FLUSH



INDICATIONS

FOR USE

Hemodialysis

Hemodialysis with infusion port



Shiley

Mahurkar


Hemodialysis RN will flush catheter.


The infusion port is flushed with 5cc of NSS and 1 cc of 10units/cc Heparin flush by the nurse caring for the patient.

The Hemodialysis RN will flush catheter.

The infusion port is flushed after each intermittent infusion or every 12 hours if not being used.



Hemodialysis available in single and double lumen.

Triple lumen dialysis catheter with third clear port used for infusions.



Approved PNC 4/06, 12/06

Approved Nursing Leadership 4/06, 12/06

Approved Critical Care Committee 4/06, 12/06



Reviewed/Revised 12/06


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