IV Therapy Policy Changes Summary for Peds/PICU

1
IV TherapyPolicy ChangesSummary for Peds/PICU

• IV antibiotics prepared on the unit need to be
  hung within 1 hour
• Chlorhexidine is used for all IV starts
• except for infants lt 7 days post term
• IV tubing is labeled with the date the tubing is
  to be changed
• New labels with the days of the week will replace
  current labels
• Proper technique for central line removal is
  clarified
• See procedure slide
• All tubing that is used intermittently
  (disconnected from the patient at least once a
  day) must be changed every 24 hours.

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IV Policy/Practice UpdateIV TUBING

• Lines Disconnected Temporarily (main IV or
  microbore)
• Place sterile cap on the end
• Do not loop it back on itself and connect to side
  port
• Do not connect it back into itself
• No blunt needles
• No black stopper from meds
• No caps from saline syringes

3
Parenteral Nutrition Reminders

• Parenteral nutrition / lipids should not hang
  longer than 24 hours.
• No filter for parenteral nutrition/ Procalamine
  ONLY
• If lipids added to same line then a 1.2 micron
  filter is used per floor set-up standards
• Any tubing with lipids running through it must be
  changed every 24 hours.
• If parenteral nutrition is non-continuous (e.g.
  night time only/intermittent), then the tubing is
  changed daily.
• In NICU parenteral nutrition tubing is changed
  every 24 hours and a 0.2 micron filter is used
  (Lipids are not filtered)

4
Removing a Central LineSteps to prevent air
embolism

• Lay patient flat, as tolerated
• Remove old dressing.
• Cleanse site with chlorhexidine
• Remove sutures or StatLock
• Instruct patient to hold their breath, if
  possible, when line is being pulled
• Remove line slowly and steadily while applying
  pressure at the site
• Hold firm steady continuous pressure to the site
  for 5 minutes
• Cover with sterile occlusive, airtight dressing
• Maintain for at least 24 hours
• Before discarding the line, examine the tip to be
  sure it is intact.

5
PICC Dressing

• Look at this picture. What was done correctly?
• BioPatch was used (blue side or writing up)
• Dressing is dated and timed
• Statlock used
• Catheter is snug as possible to the entrance
  site, but provides room for a BioPatch
• Tips for PICC line care
• If the site is covered by a 2 x 2 or gauze
  dressing then the dressing needs to be changed
  every 48 hours. Ideally gauze should not cover
  the insertion site.
• The dressing, including the StatLock and
  BioPatch, needs to be changed every 7 days or
  more often if soiled
• Use a central line dressing kit!

6
Caps

• Name that cap!

All caps changed weekly

• Microclave (B)
• A neutral pressure cap
• Used for any IV line, central or peripheral
• Line can be clamped at any time during flush

A
B
C

• CLC2000 (A)
• A positive pressure cap
• Can be used on central lines
• Line is not clamped until flush is completed
  until the syringe is removed from the cap

• Smart site (C)
• A negative pressure cap
• Used for any IV line, central or peripheral
• Line is clamped as the last ½ ml flush is
  injected.

7
Power Injectable Port-a-caths

• Two types of Power Injectable Port-a-Caths
• PowerPorts (A) made by Bard
• SmartPorts (B) made by Angiodynamics
• -Allows the use of a power injector by Medical
  Imaging
• -Verification required before port can be
  accessed with a power injectable needle
  (PowerLoc) or power injected by MI

• Can Only Be Verified By
• Identification Card carried by the patient
• Or
• Dictated Medical Record from MD who implanted the
  Port. Report must state it is a power injectable
  port.
• St Lukes Policy

Never access a regular port-a-cath with a PowerLoc
A
B
8
Discontinue IV for following conditions

• Phlebitis (inflammation of the vein) can be
  present even in the absence of redness. If the
  patient persistently complains of pain without
  redness, discontinuing the IV may be indicated.
• Infiltration the inadvertent administration of
  non-vesicant medication or solution.
• Extravasation the inadvertent administration of
  vesicant or irritating solution. Significant
  damage may have occurred before you see the
  outward appearance of necrosis. Inform physician
  immediately treatment may be available to
  minimize damage. Examples would include Wydase
  and nitro paste.

9
TKO Guidelines
Obtain an MD order with a specific rate when the
patient is ready for a TKO infusion. The
following are guidelines for different ages.

• Neonate or infant up to 3 months 1-5ml/hr
• Infants 3 months to 1 yr of age 5ml/hr
• Child from 1 to 6 years of age 10ml/hr
• Child from 6 to 12 years of age 15ml/hr
• Child from 12 to 17 years of age 20ml/h
• Adults - 40ml/hour (1000ml/24hrs)

10
Infection Prevention Tips
How long do you scrub?

• 2 chlorhexidine scrub skin
  3.15 chlorhexidine- scrub skin for 30
  seconds
  for 15 secs

Multi-dose vials expire 28 days from date opened.
Mark with expiration date when first used. If
open and not dated, discard.
Scrub caps with alcohol for 15 seconds before use.
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IV Insertion Tips

• Reduce fear and encourage cooperation
• Prepare the family and child with education
  regarding procedure, positioning, and pain
  management techniques
• Utilize Child Life when available
• Obtain supplies for pain-free IV start
• J-tip or intradermal buffered lidocaine
• 24 sucrose (Tootsweet)
• LMX / EMLA
• General Tips
• Take your time looking for a site
• Ask the family if there is a historically good
  (or bad) site
• Wee light and/or VeinViewer may be helpful
• Wear snug fitting gloves to avoid contamination
  of site and to help with assessing the site
• Use a warming pack (chemical or blanket from
  warmer)
• Try to position the patient so the site is in a
  dependent position
• With an older child have them pump their fist 4
  times, then hold (not too tight)
• Stabilize the vein by pulling the skin taut above
  or below the entrance site
• Insert catheter directly above or to the side of
  the vein depending on size, location, etc.
• When the flashback is seen, pause and advance the
  catheter, if necessary, to assure that the
  stylet and catheter tip are in the vein before
  pushing the catheter off the stylet.
• If the catheter wont advance, try advancing the
  catheter with the stylet a little more and/or
  removing the stylet and attaching the
  t-connector to advance the catheter while
  flushing.