Download Peripheral Insertion

MERCY HOSPITAL POLICIES AND PROCEDURES
PERIPHERAL INTRAVENOUS LINE:
INSERTION AND MAINTENANCE
PATIENT CARE SERVICES
Replaces
Policies
Date Effective
Revised
Reviewed – no
revisions
Applicability
IV THERAPY
 IV Medication
 Peripheral Insertion/
Removal of IV Cannula
 Saline Lock
1/8/2010
RNs
Page 1 of 3
/s/ Verno Davidson
Vice President, Patient Care Services/
Chief Nursing Officer
1/06/2010
Date
Mercy Value: Excellence
We strive for the highest standards of care for our patients’ physical, mental and
spiritual needs.
Reference other policies: Warming Cabinets
PURPOSE
The purpose of the policy is to describe the procedures for insertion and maintenance of
peripherally inserted intravenous lines. The specific procedural components are included in
attachments A & B.
DEFINITIONS
Intravenous Push: Administration of a medication directly into a vein through the injection
port of an existing intravenous line or through a previously placed intravenous catheter with
a saline lock, usually administered over 5 minutes or less.
Intermittent Infusion: Administration of a medication intravenously at specified times over a
prescribed period of time. Administration usually takes greater than 5 minutes to complete
and the medication is typically diluted to a volume of at least 20 ml.
Intravenous Fluids to Keep Veins Open (KVO): All intravenous fluids that are ordered to
keep the vein open should run approximately 50 ml per hour unless otherwise ordered.
Intravenous Continuous Infusion: Medication or solution administered continually at a
prescribed rate.
POLICY
1. Venipunctures are initiated by credentialed professionals who have demonstrated
competence inserting and maintaining peripheral intravenous lines. (Please refer to
Appendixes A+B for the competency.)
2. An order from the prescriber is required for insertion of a peripheral intravenous line.
MERCY HOSPITAL POLICIES AND PROCEDURES
PATIENT CARE SERVICES
PERIPHERAL INTRAVENOUS LINE: INSERTION AND
MAINTENANCE
IV THERAPY
Page 2 of 6
3. The nurse is expected whenever possible to utilize the drug libraries in the infusion
pump. Please contact pharmacy if a drug is not found in the drug libraries. Please refer
to the Plum Infusion Pump instructions in Appendix A.
4. Unless allergic, patients may be offered Lidocaine, Buffered Lidocaine or EMLA cream
as described below to decrease pain during intravenous line. The following are standing
orders that will be profiled by pharmacy and entered on the medication administration
record:
 Lidocaine 1% administer 0.1 ml intradermally prior to intravenous line insertion
PRN
 Buffered Lidocaine 1% administer 0.1ml intradermally prior to intravenous line
insertion PRN
 EMLA cream apply the following based on age and body weight requirements:
PRN
Age and Body Weight
Requirements
0 up to 3 months or < 5 kg
3 up to 12 months and > 5
kg
1 to 6 years and > 10 kg
7 to 12 years and > 20 kg
Maximum Total
Dose of EMLA
Cream
1g
2g
10g
20g
Maximum
Application Area
Maximum
Application Time
10 cm2
20 cm2
1 hour
4 hour
100 cm2
200 cm2
4 hour
4 hour
5. All venipuncture sites are prepared using Cloraprep.
6. Follow the principles of SAVE the line:
Scrupulous hand hygiene
Aseptic technique
Vigorous friction to hubs with alcohol wipe for 10 seconds
Ensure Patency
7. Irrigate the saline lock with 10 ml of 0.9% sodium chloride every 8 hours and use the
 S-A-S method when administering medications:
 Sodium Chloride
 Administer medications
 Sodium Chloride
8. All peripheral IV sites will have an occlusive dressing unless otherwise indicated.
9. Peripheral dressing changes occur:
 Every 96 hours and when soiled if an occlusive dressing is covering the site
 Every 48 hours and when soiled if a gauze dressing is covering the site.
10. All peripheral intravenous sites will be changed every 96 hours or with any signs of
infiltration, erythemia, purulence at the site. If the IV site must be maintained beyond 96
hours then the provider must write an order to extend the dwell time by 24 hours and a
new order must be written with every 24 hour extension.
MERCY HOSPITAL POLICIES AND PROCEDURES
PATIENT CARE SERVICES
PERIPHERAL INTRAVENOUS LINE: INSERTION AND
MAINTENANCE
IV THERAPY
Page 3 of 6
11. All peripheral cannulas inserted outside the hospital setting, or under potentially nonaseptic conditions shall be removed and a new line inserted within 24 hours of
admission to the hospital. If the peripheral cannula is not removed at 24 hours an order
from a prescriber, which must be renewed every 24 hours, is required to maintain the
site.
12. Unless otherwise stated intravenous solutions shall be changed every 48 hours
13. Intravenous administration sets are changed every 96 hours unless otherwise specified.
14. Blue claves are changed with every site or tubing change and does not need to be
changed after blood infusion.
15. All solutions and tubing are labeled with the date.
16. Intravenous infusions are assessed hourly for accuracy of the rate of infusion and signs
or symptoms of infiltration and phlebitis.
17. Saline locks are assessed during routine flushing and with medication administrations.
18. When indicated a blood warmer may be used to warm fluids for infusion (Refer to
Warming Cabinets policy).
19. When an intravenous line infiltrates or there are any signs or symptoms of phlebitis or
the intravenous line is changed sooner than 96 hours, the event is documented in the
medical record and in the MIDAS+ system.
20.
REFERENCES
1. Gahart, B.L. (2009). 2009 Intravenous Medications. Mosby, St.Louis, MS.
2. Hankins, Lonsway, Hedrick and Perdue (2008). Infusion Therapy in Clinical Practice.
New York, NY: W. B. Saunders.
3. O’Grady, N. P., MD. (2002, August). Guidelines for the Prevention of Intravascular
Catheter-Related Infections. MMWR Recommendations and Reports, Volume # 51, RR
RR-10.
4. Blood compatibility studies conducted by the Hospira Company.
APPENDIX A
COMPETENCY CHECKLIST: PERIPHERAL VENIPUNCTURE
NAME
UNIT
DATE
COMPETENCY
INSERTION:
1. Verify prescriber order.
2. Obtain IV equipment
3. Perform hand hygiene and follow guidelines for Standard Precautions.
4. Explain procedure to patient.
5. Instruct patient to report any pain, burning, stinging, edema, redness at site.
6. Don gloves.
7. Apply tourniquet proximal to proposed puncture site.
8. Determine appropriate site for venous access.
9. Release tourniquet.
10. Prepare equipment to be used, including IV start kit, primed J-Loop, IV catheter,
2x2 gauze (or Op-Side dressing), and normal saline.
11. Cleanse area with chloraprep using a gentle back-and-forth scrubbing motion for
30 seconds. Allow to dry. DO NOT re-palpate after cleansing..
12. Reapply tourniquet.
13. Select appropriate catheter size/type and opens package.
14. Puncture skin at 45 degree angle, bevel up.
15. Reduce angle; slowly advance catheter and observe for blood return.
16. When blood return is seen, release tourniquet.
17. Insert catheter following appropriate procedure for needle type.
18. Remove needle from catheter and attaches primed J-Loop extension tubing.
19. Flush with 1 to 2 ml normal saline and assesse for signs of infiltration; if no
infiltration, complete flushing (total 3 to 5 ml with normal saline).
ADMINISTRATION OF LIDOCAINE:
21. Lidocaine and Buffered Lidocaine may be used for numbing according to standing
orders described in the policy
22. Draw 0.2ml of 1% Lidocaine or Buffered Lidocaine in a TB syringe. Use a 26 to 30
gauge needle.
23. Hold skin distal to cannulation site taut. Insert intradermal needle (bevel up) under
skin up to the length of the Bevel. (Relaxing hold on skin will allow bevel to enter
skin easily. Aspirate to be sure you are not in vein). Inject approximately 0.1 ml of
1% lidocaine. Observe for bleb. Bleb will disperse within 30 seconds causing
numbness at site
ADMINISTRATION OF EMLA CREAM:
24. EMLA Cream may be applied topically for numbing according to the standing
orders described in the policy.
26. Prepare two sites by applying prescribed amount to both sites.
27. Cover one site with transparent dressing and second site with clear wrap or
another transparent dressing.
28. When ready to begin procedure, wipe off EMLA and prepare for intravenous
insertion.
DOCUMENTATION:
29. Document site, size, blood return and gauge of catheter on the Medical/Surgical
flowsheet.
MET
NOT
MET
APPENDIX B
PERIPHERAL IV INSERTION CERTIFICATION
NAME
UNIT
Performance Checklist
DATE
#1
#2
1. Verify presciber order
2. Explain procedure to patient
3. Use Standard precautions
4. Perform hand hygiene
5. Administer lidocaine, buffered lidocaine or EMLA
6. Select appropriate site
7. Apply tourniquet and distend vein appropriately
8. Prepare skin with chloraprep
9. Successfully insert catheter into vein
10. Apply appropriate dressing
11. Label site
12. If not saline lock, hang solution, titrate rate
13. Document site, size catheter, time on flow sheet
14. document IV solution in the EMAR and I & O sheet
I have supervised the above named RN in completing a successful peripheral IV insertion
according to above criteria.
Venipuncture:
#1
Date: #1
#2
Date: #2
#3
Date: #3
#3
MERCY HOSPITAL
PCS POLICIES AND PROCEDURES
REVIEW FORM
Policy name
Peripheral Intravenous Line: Insertion and Maintenance of
Policy location
IV Therapy
Policy Owner – Name, Title
Terri Mathew, Clinical Nurse Educator
Review initiated (date)
July 2009
Reviewed for:
(check all that apply)

Relevance to other policies/procedures

Relevance to Standards of Care/Practice

Regulatory requirements
New policy?
Review completed
Yes
No
Nov 2009
Ethical and legal concerns

Documentation of evidence-based practice

Feedback from key stakeholders
Reviewed by
(Individuals, committees)
Date of review
Reason for review
PCS Practice and Quality
Council
11/11/09
 NEW POLICY
Deborah Swett RN
7/8/09
3-year review: no changes needed
REVISED POLICY (briefly describe revisions)
Vascular Access Specialist
Pharmacy & Therapeutics
Committee
11/18/09
Replaces and combines the following policies
 IV Medication
 Peripheral Insertion/ Removal of IV Cannula
 Saline Lock
Use and practice of EMLA cream changed
All IVs started in field now changed within 24 hrs. If
necessary to maintain site beyond 24 hrs, a
physician order is required.
DISCONTINUE POLICY (brief reason below)