Download converting a continuous peripheral intravenous infusion to saline or

CONVERTING A CONTINUOUS PERIPHERAL INTRAVENOUS
INFUSION TO SALINE OR HEPARIN LOCK
PURPOSE
To outline the policy and procedure for flushing a peripheral intravenous device or converting a continuous
peripheral intravenous infusion to a saline or heparin lock.
POLICY STATEMENTS
A registered nurse may initiate a saline lock for peripheral infusions without a physician order when the
infusion is not required for fluid requirements, parenteral nutrition, medication or blood product
administration.
The use of heparin lock solution for flushing a peripheral intravenous device requires a prescriber’s order. If
the prescriber orders “heparin lock peripheral IV”, Heparin 10 units/mL solution is used unless otherwise
ordered.
A peripheral intravenous used for intermittent infusions is flushed and locked immediately following use.
If a peripheral intravenous device is insitu but is not being used for any infusion, routine flush is done every
12 hours.
For patients in the Emergency department, Ambulatory care or out on pass returning every 24 hours for IV
medications the catheter is flushed only following medication infusion (i.e. every 24 hours). A positive
pressure cap is used to create positive displacement in these situations.
The practice of running an intravenous at a minimum rate will be done only if a specific rate is ordered. To
Keep Vein Open (TKVO) orders will be interpreted as saline lock unless:
o
o
The physician identifies an immediate need for access
IV access is required again within the next 2 hours.
SITE APPLICABILITY
Applicable to all patient care areas.
PRACTICE LEVEL/COMPETENCIES
Flushing a peripheral intravenous device or converting a continuous peripheral intravenous infusion to a
saline or heparin lock is a foundational nursing competency.
EQUIPMENT
o
o
o
o
o
needleless connector or positive pressure cap
pre-filled syringe of Sodium Chloride 0.9%, without preservative and/or heparin flush 10
units/mL
2% Chlorhexidine in 70% alcohol wipes
tape
Swabcap™
PROCEDURE
Rationale
1. CHECK chart for prescriber order if heparin
locking.
As no difference in patency has been established,
using saline as a flush solution is preferable to
heparin in peripheral intravenous locks, given the
greater likelihood of complications associated with
heparin.
Facilitates completion of procedure in a timely
fashion.
Routine Infection Control Practices.
Ensures identification mechanism is present to
prevent treatments, medications, and procedures
2. ASSEMBLE equipment.
3. PERFORM hand hygiene.
4. VERIFY patient identity and EXPLAIN
procedure.
LastReviewDate
CV.02.05
Aug 27, 2012
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
BCCH Child & Youth Health
Policy
Mar 19,
1993 and Procedure Manual
Effective Date: Jan 18, 2016
Page 1 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 20, 2016 20:48
Generated By
Anonymous
CONVERTING A CONTINUOUS PERIPHERAL INTRAVENOUS
INFUSION TO SALINE OR HEPARIN LOCK
5. CLAMP IV catheter tubing and TURN OFF
infusion pump.
6. DISCONNECT tubing from one-piece
needleless connector. PROTECT intravenous
tubing tip with sterile dead-end cap if
intravenous to be reconnected within 24 hours.
7. SCRUB needless connector with
chlorhexidine/alcohol swab for 30 seconds and
allow to dry for 1 minute.
8. ATTACH syringe with saline or heparin to
needleless connector, UNCLAMP IV catheter
tubing, and FLUSH device with 1 mL saline (or
heparin if ordered) solution using positive
pressure (clamp catheter while instilling. Do not
totally empty syringe). Repeat following next
medication infusion or every 12 hours if not
being used for infusions.
NOTE: For patients returning in 24 hours for
medication infusion, apply primed positive pressure
cap if not already in situ and flush with 1 mL saline
(or heparin if ordered) solution. Remove syringe
and then clamp tubing. Repeat every 24 hours
following medication infusion.
9. ASSESS intravenous site for signs and
symptoms of complications (phlebitis, infiltration,
occlusion) prior to any medication infusion or
routine flush. If any complications noted, resite
IV.
10. ATTACH Swabcap™ to needleless connector
unless contraindicated (i.e. choking hazard).
11. REMOVE equipment and dispose appropriately.
PERFORM hand hygiene.
to wrong child.
Stops infusion.
Tubing used for intermittent medication infusion
and disconnected from IV catheter is changed
every 24 hours.
Aseptic technique.
Prevents blood reflux into catheter.
Positive pressure cap creates positive
displacement of fluid when removing syringe.
Prevents infusion related complications.
When re-accessing, scrubbing of cap is not
necessary if Swabcap™ insitu.
Routine Infection Control Practices.
DOCUMENTATION
DOCUMENT on Medication Administration Record (MAR) or other unit approved record in areas where
MARs are not used:
o
procedure and time
o
patency of IV
o
amount of saline or heparin flush
o
patient response to procedure.
REFERENCES
Arnts, I.J.J., Heijnen, J.A., Wilbers, H.T.M, van der Wilt, G., Groenewoud, J.M.M. & Liem, K.D. (2011).
Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in
neonates: a double blind randomized controlled study. Journal of Advanced Nursing, 67(12):26772685.
Boyce, JM and Pittet, D. (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations
of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA
LastReviewDate
CV.02.05
Aug 27, 2012
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
BCCH Child & Youth Health
Policy
Mar 19,
1993 and Procedure Manual
Effective Date: Jan 18, 2016
Page 2 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 20, 2016 20:48
Generated By
Anonymous
CONVERTING A CONTINUOUS PERIPHERAL INTRAVENOUS
INFUSION TO SALINE OR HEPARIN LOCK
Hand Hygiene Task Force. Centers of Disease Control and Prevention. MMWR Recommendations
Report. 51(RR16):1-44.
Campbell, SG, Trojanowski, J, and Ackroyd-Stolarz, SA. (2005). How Often Should Peripheral Intravenous
Catheters in Ambulatory Patients Be Flushed? Journal of Infusion Nursing, 28(6):399-404.
Davenport, D.E. and Utterback, V.A. (2011). Physics and flushes: The science supporting why we do what
we do. Nursing, 41(8):65-66.
Garros, D., King, J., Brady-Fryer, B. & Klassen, T.P. (2003). Strangulation with Intravenous Tubing: A
Previously Undescribed Adverse Advent in Children. Pediatric,. 111(6):732-734.
Hadaway, L. (2012). Personal correspondence re: frequency of saline locking peripheral intravenous
devices. Lynn Hadaway Associates, Inc.
Health Canada. Notice to hospitals: Risk of strangulation of infants by IV tubing and monitor leads. Ottawa:
Health Canada, July 30, 2002. Retrieved August 7, 2007 from: http://www.hc-sc.gc.ca/dhpmps/medeff/advisories-avis/prof/_2002/iv_tubes_nth-ah-eng.php.
Health Canada. Notice to Hospitals: Update: Risk of strangulation of infants by IV tubing and monitor
Leads. Ottawa: Health Canada, December 29, 2003. Retrieved from: http://www.hc-sc.gc.ca/dhpmps/medeff/advisories-avis/prof/_2003/iv_tubes_2_nth-ah-eng.php.
Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice. Journal of Infusion Nursing,
34(1S).
Infusion Nurses Society. (2010). Infusion Nursing an Evidence-Based Approach. St. Louis, Missouri:
Saunders Elsevier.
Lunetta, P. and Laari, M. (2005). Strangulation by Intravenous Tubes. The Lancet, 365(9470):1542.
Mok, E., Kwong, T.K.Y., & Chan, M.F.(2007). A randomized controlled trial for maintaining peripheral
intravenous lock in children. International Journal of Nursing Practice, 13(1):33-45.
O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur,
H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Rupp, M.E., Saint, S. and the Healthcare
Infection Control Practices Advisory Committee (HICPAC). (2011). Guidelines for the prevention of
intravascular catheter-related infections, 2011. Centers of Disease Control and Prevention.
Retrieved from http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html.
LastReviewDate
CV.02.05
Aug 27, 2012
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
BCCH Child & Youth Health
Policy
Mar 19,
1993 and Procedure Manual
Effective Date: Jan 18, 2016
Page 3 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact [email protected] with questions.
Date/Time Generated
Oct 20, 2016 20:48
Generated By
Anonymous