Note: This guideline is currently under review. Show Introduction Aim Definition of terms Assessment Management Companion Documents References Evidence Table IntroductionPeripheral intravenous catheters (PIVC) are the most commonly used intravenous device in hospitalised patients. They are primarily used for therapeutic purposes such as administration
of medications, fluids and/or blood products as well as blood sampling. AimThe aim of this guideline is to provide an outline of the ongoing maintenance and management of the PIVC for patients in hospital, outpatient, and home healthcare settings. For information related to insertion of PIVC, please refer to
intravenous access guideline . Nurses who are deemed competent in IV insertion could continue to insert PIVC in consultation with NUM/CSN’s. Definition of terms
AssessmentPatient and IV site assessments should be done on a regular basis. PIVC assessment includes:
ManagementAdministration of intravenous fluid, drug infusions or blood products a) Continuous infusion of IV fluids
Infusion Pump Pressure
If pump pressure exceeds the recommended limits, check the patency of the PIVC. b) Administration of bolus/loading doses: Administering drugs: Drugs administered via PIVC may be
The most appropriate method should be selected depending on volume of diluent required, patient condition, fluid balance and intended rate of delivery. Drugs administered via:
Attach
a completed drug label detailing the drug, dose, diluent, volume of diluent, date, time and signature of the nurse and the staff who double checked. Access PIVC only after cleaning the access port and scrub the hub. For intermittent infusions, IV lines which are disconnected are to be discarded between infusions. Ensure the cannula is flushed with normal saline once the giving set is disconnected from the cannula. For Opioid infusion bolus refer to the specific
guidelines: Children’s Pain Management Service (CPMS)(opioid infusion guideline) Administering blood products:
Flushing of PIVC’s
Change of PIVC dressing and securement of cannula:
Change of Extension sets
IV Fluid Considerations via Peripheral IV line Which Fluids and how much fluids to use
Labeling infusions:
Fluid bag and infusion changes:
Line changes
Table 1.Changing IV bags and lines
Removal of PIVCs: There is no evidence for routine replacement of PIVC unless clinically indicated. PIVC’s should be maintained with regular assessment and documentation of complications.
Management of complications There are a range of complications that could
occur with the presence of a PIVC in insitu. Some of these complications can be prevented by the correct use of aseptic technique for insertion and maintenance as well as assessing the device as indicated.
Companion Documents
References
Evidence Table The evidence table can be found here. The development of this nursing guideline was coordinated by Mercy Thomas, Nursing Educator, and approved by the Nursing Clinical Effectiveness Committee. Updated December 2018. How the skin is held prior to inserting the needle?Displace the patient's skin in a Z-track manner by pulling the skin down or to one side about 1 inch (2 cm) with your nondominant hand before administering the injection. With the skin held to one side, quickly insert the needle at a 90-degree angle.
Where are the subcutaneous injection sites?The best areas on your body to give yourself a SQ injection are:. Upper arms. At least 3 inches (7.5 centimeters) below your shoulder and 3 inches (7.5 centimeters) above your elbow, on the side or back.. Outer side of upper thighs.. Belly area.. Which step should the nurse take before injecting insulin subcutaneously?Prior to injecting the medication, inspect the skin area. Avoid skin areas that are bruised, open, scarred, or over bony prominences. Medical conditions that impair the blood flow to a tissue area contraindicate the use of subcutaneous injections in that area.
What is the site for intradermal injection?Intradermal injections (ID) are administered into the dermis just below the epidermis. Use a tuberculin syringe, calibrated in tenths and hundredths of a milliliter, with a needle length of 1/4 inches to 1/2 inches and a gauge of 25 – 27 Page 2 ID injections may be given on the inner aspect of the forearm.
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