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Carolyn McCune, RN, MSN, CRNP Teresa Peck RN, BSN  Review syllabus and course requirements  Answers any questions related to class  www.emprocedures.com/index.htm  Then go to Peripheral IV access 4723.171 Intravenous therapy procedures. (A) A licensed practical nurse may perform on any person any of the intravenous therapy procedures specified in division (B) of this section without receiving authorization to perform intravenous therapy from the board of nursing under section 4723.17 of the Revised Code, if both of the following apply: (1) The licensed practical nurse acts at the direction of a registered nurse or a licensed physician, dentist, optometrist, or podiatrist and the registered nurse, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication. (2) The licensed practical nurse can demonstrate the knowledge, skills, and ability to perform the procedure safely. (B) The intravenous therapy procedures that a licensed practical nurse may perform pursuant to division (A) of this section are limited to the following: (1) Verification of the type of peripheral intravenous solution being administered; (2) Examination of a peripheral infusion site and the extremity for possible infiltration; (3) Regulation of a peripheral intravenous infusion according to the prescribed flow rate; (4) Discontinuation of a peripheral intravenous device at the appropriate time; (5) Performance of routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion. Effective Date: 04-10-2001  First began in the 17th century  19th century-infection control procedures  mid 1950’s-used for surgery and hydration(20%)  Today approximately 90 % of pts in hospital receive IV’s  Skilled nursing homes, doctors office and home  Fluid and electrolyte maintenance, restoration and replacement  Administer medications and nutritional feedings  Give blood and blood products  Chemotherapy  Patient controlled analgesics  KVO for quick access  Oral medications-absorbed in the digestive tract  IV- faster acting and distributed throughout the bloodstream immediately after giving  Unconscious pt:  Unable to swallow:  Vomiting:  Nutrition:  Others?  Slides 3-6-material from Fulcher and Frazier(2007)  Pre-existing vascular compromise  Regional infection  Adult:  Antibiotic:  Arterial Line:  Aspirate:  Central Line:  Central Venous Access Device: (CVAD’S)  Continuous Infusions:  Controlled Analgesic:  Drip Factor:  Electronic Pumps and Controllers:  Flow Rate:ml/hr or gtts/min  Infiltration:  Infusion Devices:  Thru peripheral IV sites-depend on gravity for administration- must be 24-36 inches above IV sites  If patient changes positions volume decreases-back pressure greater, rate slows or stops  Simplest controllers-roller or slide clamp  Use to speed up or slow, counts gtts in drip chamber  Apply external pressure to administration set tubing to run at specified rate  Specific volume/time  More accurate  Alarm systems-kinks, air, occlusion  Disadvantage-Cost of equipment, maintenance, more serious infiltration. SYRINGE  Holds PUMPS prefilled syringe  Positive pressure to plunger delivers specific volume  Used for small volume  Insulin pumps, PCA pumps  Safer, preprogramming to prevent calculator errors  Initiate:  Intermittent Infusion: (Piggyback)  Intravenous: (IV)  IV Bolus:  IV Push:  Maintain  Nurse Practice Act: (Ohio)  Palpation:  Peripheral:  Peripherally Inserted Central Catheters: (PICC’s)  Phlebitis:  Piggyback:  Roller clamp:  Tourniquet:  TPN:  Transparent Dressing:  Venipuncture:  Other Terms:  Questions????????  Apparatus that connects large volume parenteral solution with IV access device into patient veins  Insertion spikes  Clip chamber  Plastic tubing with rate control clamp  Rubber injection port  Needle adapter and protective cap on needle adapter  Over needle cath left in for medical administration  Flush every 8 hours  Flush before/after meds  See Handout from OBN website  Chapter 4723-17  Try to access sites