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IV Insertion and Management

e-Module

IV Insertion and Management

Purpose
The purpose of this e-learning module is to
educate the healthcare team on IV insertion and
management

This module is not intended to be all inclusive, but rather provides an


overview of salient points related to IV insertion and management.

e-Module

IV Insertion and Management

Who may start an IV?


Peripheral intravenous (PIV) catheters may be
inserted by health care providers whose
competency has been validated.

RN
MD
NP
PA
LPN * Check site and local policy

e-Module

IV Insertion and Management

Policy
Peripheral IV (PIV) catheters should be
changed to a new site every 96 hours.
The site must be assessed as per protocol
Frequency of monitoring a peripheral
intravenous site is determined by the
prescribed therapy (i.e. chemo, blood, TPN,
medications), the condition and age of the
patient and the practice setting

e-Module

IV Insertion and Management

Extenuating Circumstances
All PIV catheters should be changed to a new site
every 96 hours (4 days) or as needed

Nursing assessment of patients available peripheral venous


access and/or the condition of IV site determines if PIV
should stay in place longer than 96 hours (4 days).

Extenuating circumstances necessitating extending the above


time frame will require notifying the physician of the need to
extend the time frame due to venous access and obtaining an
order for a maximum of an additional 24 hours for a total of
120 hours (5 days).

e-Module

IV Insertion and Management

Peripheral IV that was inserted at


another location may be retained if:
IV is inserted within 96 hours
The site is without complications (of pain, redness,
swelling, drainage).
Equipment (catheter, extension set, needless connector,
and dressing) are appropriate and current as per policy.

These criteria also applies to peripheral IVs inserted by


EMS.

e-Module

IV Insertion and Management

Policy
All peripheral IVs used intermittently must be
flushed every 12 hours and after each use
with a prefilled 5ml syringe of sterile sodium
chloride 0.9% and clamped.
All IVs are started with an medlock extension
set attached to the catheter.

Medlock
Extension
set

e-Module

IV Insertion and Management

Site Selection
Carefully examine both arms for most
appropriate vessels
Most commonly used veins for placement of
IV catheters are:
Metacarpal
Cephalic

Basilic

e-Module

IV Insertion and Management

Lower Extremity
PIV insertion in a lower extremity:
requires a valid order

should utilize the smallest gauge catheter


appropriate for the therapy ordered
requires the patient be on bed rest
should be changed to an upper extremity or
to a central line as soon as possible
must be placed by NP, PA or MD

e-Module

IV Insertion and Management

Things to Consider
Location of vein
Condition of vein
Purpose and type of infusion

Duration of therapy
Catheter material
Catheter size needed to delivery therapy
Patients age, diagnosis, prior surgeries,
procedures

Patient activity
Patient preference
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e-Module

IV Insertion and Management

Avoid
Do not use veins in affected arm of patients
with:
history of mastectomy

hemodialysis shunt or fistula


axillary dissection or biopsy
surgical procedures

Limb restriction band


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e-Module

IV Insertion and Management

Avoid
Joint regions
Sclerotic veins
Site near recent complication

Site under restraints; Inner wrist


Locations with impaired circulation
Legs and feet

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e-Module

IV Insertion and Management

Getting Started

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e-Module

IV Insertion and Management

Ensure a valid written order

Date
9/3/10

Time
1230

Order
IV Lock

Signature
Bob Cohen,MD

Contact #
Beeper 1913

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e-Module

IV Insertion and Management

Wash Hands
Standard infection control practices require
the use of aseptic technique.

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e-Module

IV Insertion and Management

Identify Patient
Every Patient - Every Encounter

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e-Module

IV Insertion and Management

Check for Allergies


Check the allergy band.
Ask patient if he/she has any known
reactions to ChloraPrep or anything else.

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e-Module

IV Insertion and Management

Explain Procedure to Patient


Tell the patient what you are going to do

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e-Module

IV Insertion and Management

Equipment
IV start kit
Angiocatheter
CLAVE Extension Set

Saline IV flush

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e-Module

IV Insertion and Management

Prime CLAVE Extension Set


Flush extension set with
normal saline.
Clave must be cleansed with
alcohol after initial flush
whenever IV lock is accessed

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e-Module

IV Insertion and Management

CLAVE (bigger picture)


Never use needles or blunts

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e-Module

IV Insertion and Management

Peripheral IV Start Kit contents:


Drape

Hubguard

Tourniquet

Alcohol prep

Gloves

Dressing

ChloraPrep

Label

2X2 gauze

Tape

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e-Module

IV Insertion and Management

Open the IV Start Kit

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e-Module

IV Insertion and Management

Place Drape Under Extremity

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e-Module

IV Insertion and Management

IV Angiocatheter
Open your angiocatheter

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e-Module

IV Insertion and Management

Angiocatheter Gauge Selection


Key points to consider:
Type of intravenous solution or medication
Type of procedure or surgery to be performed

Patients diagnosis
History of IV therapy
Patients activity level
Patients age
Venous status

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e-Module

IV Insertion and Management

Size Does Matter


Select the device with the shortest length and
the smallest diameter that allows for proper
administration of the prescribed therapy.
Note:
The smaller the gauge number, the bigger the
diameter.
Example: 18 gauge is bigger than 24 gauge.

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e-Module

IV Insertion and Management

16 Gauge & Larger


Uses:
High-risk surgical
procedures
Large fluid and blood
volumes

Rapid infusions

18 Gauge

Uses:
Surgery
Improved flow rate
for viscous solutions
and blood
transfusions

Rapid infusions

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e-Module

IV Insertion and Management

20 Gauge
Uses:
Most routine infusions
Minor surgical
procedures
Routine outpatient
procedures requiring IV
access
Appropriate for blood
components, when
rapid rates are not
required

22 Gauge
Uses:
Most routine
infusions
Delivery of
antibiotics
Hydration
therapy at slower
rates
Small or fragile
veins

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e-Module

IV Insertion and Management

IV INSERTION VIDEO
Click below to watch a 4 minute video of IV
insertion technique using the angiocatheter
utilized at NSLIJHS.

http://www.bd.com/infusion/products/ivcatheters/autoguard/flash/video.asp

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e-Module

IV Insertion and Management

Upon completion, place angiocatheter in


Sharps Container
Angiocatheter needle should be retracted
prior to disposal in the sharps container (by
pressing the white button as demonstrated in
the video).

Remove gloves
Place all other used equipment in regular
garbage.

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e-Module

IV Insertion and Management

Wash your hands


Provide patient education

Activity restrictions
Notify nurse if any pain, swelling, burning,
redness or discomfort at site, or if any blood
in IV lock or tubing
Avoid any pressure to IV site
Signs and symptoms of complications
What and when to report signs and symptoms to the health care team
Activity and restrictions
How to care for the line

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e-Module

IV Insertion and Management

Document in appropriate area of medical


record:

Date of insertion
Time of insertion (in military time)
Anatomic location of the insertion site
Type and gauge of catheter
Patient tolerance
Patient teaching

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e-Module

IV Insertion and Management

An Untoward Event..
Provide appropriate
intervention

infiltration

Document in progress
notes
Include description of
event
.

multiple attempts
hematoma
infiltration

Vessicant
infiltration

hematoma

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e-Module

IV Insertion and Management

Adding IV solution to your


newly inserted IVLock

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e-Module

IV Insertion and Management

Peripheral IV (PIV) tubing policy


PIV tubing is changed every 96 hours

Exceptions:
-PPN tubing every 24 hrs
-Blood and blood products every 4 hours or with each transfusion
-Lipid based medications every 12 hours.
-IV tubing used for intermittent administration of IV fluid and
medications will be changed every 24 hours.

Peripheral IV (PIV) fluid policy


PIV fluid bag is changed every 24 hours.
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e-Module

IV Insertion and Management

Intermittent Piggyback Policy


If a secondary line is used intermittently (not
through a running main line) and connected
directly to a IV lock, that tubing must be
changed every 24 hours.
Any tubing that is not capped after use is
considered contaminated and must be
discarded immediately.

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e-Module

IV Insertion and Management

IV site assessment policy


PIV site should be reassessed every 2 hours
and documented on the patient care record.

Assessment includes determining if: dressing


is dry and intact, and the site is without
redness, swelling, drainage, or pain.
Frequency for monitoring may be increased
based upon prescribed therapy (i.e. chemo,
blood, PPN, medications), the condition and
age of the patient, and practice setting.

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e-Module

IV Insertion and Management

Attaching an IV infusion
IV fluid bag (per order)
IV tubing

Tubing and bag labels

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e-Module

IV Insertion and Management

Setting the Drip (Infusion) Rate


All pumps in the NSLIJHS have the capacity to
calculate infusion rates. In the event of failure,
you will need to able to calculate an infusion rate

Drip rate formula:


(Amount in mL) X (tubing drop factor)
Time for delivery in minutes
(100mls to deliver) x (drop factor of 10)
60 min

= # of gtts/min
= 16.6 or
17gtts/min

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e-Module

IV Insertion and Management

IV Solution
Start IV solution and adjust flow rate.
Protect against accidental dumping of IV
fluids (leaving the roll clamp open and
allowing rapid infusion of fluid,
inadvertently).

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e-Module

IV Insertion and Management

Labeling
Write date on IV tubing using a sticker
Write date and time on IV solution using a
sticker.
Include type and amount of solution hung, time
started and flow rate

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e-Module

IV Insertion and Management

You have completed this module

Competency validation will occur through


return demonstration of an IV insertion.

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e-Module

IV Insertion and Management

References
NSLIJHS System Nursing Policy and Procedure
Committee (2013, June 11). IV insertion
(peripheral) adult. Retrieved from:
https://nslijhp.northshorelij.com/NSLIJ/policies/
Pages/default.aspx

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e-Module

IV Insertion and Management

Post Test
It is required that you take an online post test after
module completion.
Click on this Link to Access:
https://nslijhp.northshorelij.com/nursing/EWD/Pages/Nursing
QuizSystemSYS.aspx?user_facility=system&user_quiz=syste
m-IV-insertion

Passing score = 100%

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