IV THERAPY - Greater Baltimore Medical Center



IV THERAPY

GBMC does not have an IV therapy team. It is the expectation of all nurses that they will start peripheral IV’s as well as have the knowledge to care for central venous access.

• All IV sites are to be changed every 72 hours. If the IV cannot be changed, a physician order must be obtained to leave the IV in place another 24 hours. This order must be obtained daily.

• All IV tubing must be changed every 72 hours.

• All IV bags must be changed at least every 24 hours.

• Adult KVO rates are 30-50cc/hr unless otherwise ordered by the physician, or as dictated by patient diagnosis.

• Peripheral medicine locks are flushed with 1cc of Normal Saline every 8 hours.

• Central lines are flushed every 12 hours with the appropriate flush, as outlined in the attached Central Line policy/chart.

• For all inpatient areas, IV assessments, starts, and discontinues are documented on the IV assess / invasive line status intervention in Meditech.

• For all inpatient areas, all IV fluid volume documentation is entered on the IV Intake Spreadsheet in Meditech.

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GBMC

CLINICAL POLICY AND PROCEDURE MANUAL

SURGICAL SERVICES

CENTRAL VENOUS ACCESS DEVICE

Approval:

Signature on file:

V. P. Nursing, CNE

I. PURPOSE

To provide guidelines for the care of the patient with a central venous access device.

II. POLICY

Types of devices most commonly used at GBMC

a. Non tunneled device—Arrow Triple Lumen Catheter (TLC), Peripherally Inserted Central Catheter (PICC), Power PICC** and Power TLC**

b. Tunneled device—Hickman catheter and the Groshong catheter, and Power Hickman**

c. Implanted device—Port-a-cath, R-port and Power port** (power port must be accessed with power needle for CT scans)

d. Vascular Sheaths—used in the insertion of Temporary Pacemakers and Pulmonary Artery Catheters (Critical Care only)

e. Hemodialysis Access devices—cared for and flushed by the Hemodialysis Nurses.

f. **Power venous access devices are used with the power injector needed for CT scans. They are purple in color and are cared for the same as their non-power counterpart.

All fluids running through a central venous access device must be on an infusion pump.

Registered Nurses and Licensed Practical Nurses who have shown competency through the orientation process can draw blood from, flush, dress, access or attach fluids to a central venous access device.

Anti-reflux valves must be on the ports of all lines or on the port of the needle for implanted devices. These valves should be changed every 72 hours at the time the IV tubing is changed.

MICU, SICU, CCU and Emergency Department nurses may discontinue

a Triple Lumen Catheter or venous vascular sheath with a physician order—Follow procedure in AACN Procedure Manual for Critical Care page 498-501.

Upon receipt of a physician order, Registered nurses in the following department/job category may treat thrombo-occlusions of central lines with t-Pa: MICU, SICU, CCU, Emergency Department, U38, U34, Interventional Radiology, Infusion Therapy, Educators/Clinical Specialists/Nurse Education Specialist. (See Critical Care policy—Declotting Central Venous Access Devices)

Dressings on all central venous access devices are to be changed every 7 days with the application of Biopatch supplied in the Central line Dressing Kit and the Port Access Kit. Date, time and initial all central line dressings. Include date of insertion and date of dressing change.

Non-coring needles (Huber) are changed every 7 days.

Fluids must be changed every 24 hours and tubing every 72 hours per GBMC Intravenous therapy policy.

III. CENTRAL LINE PROCEDURES: Follow procedures in Clinical Nursing Skills and Techniques by Perry and Potter, Chapter 19 pages 604-613 with these exceptions.

a. Dressing Change-use Central Line Dressing Kits

1. Use Chloroprep supplied in kit in place of alcohol and providone-iodine

2. Do not use gauze to cover insertion site

3. Use BioPatch dressing over insertion site and under transparent dressing.

b. Flushing-follow guidelines on Central Catheter Chart (Appendix A)

ORIGINAL: 7/88

REVIEWED: 3/90, 11/91, 1/93, 11/95, 10/98, 02/03

REVISED: 12/90, 10/93, 03/04, 04/06, 12/06

Appendix A

All catheters should be flushed according to manufacturers guidelines. The following is a chart containing those catheters most frequently used at GBMC.

Implanted Devices

|NAME OF |BRAND NAME OF |VOLUME OF FLUSH |FREQUENCY OF FLUSH |INDICATIONS |

|CENTRAL CATHETER |CATHETER | | |FOR USE |

|R-Port |Medi-Tech |1. Normal Saline 10 cc |1. After each |The R-port is implanted peripherally under |

|Peripheral Infusion | |Heparin |medication and blood |the skin in the non-dominant arm and is used |

|Device | |5 cc of 100 units/cc |draw--use pulsatile |for long-term access. All types of fluids and|

| | | |(start/stop) flush |medications may be infused. May be used for |

| | |2. Normal Saline -20 cc |technique. |blood sampling. May be used with gravity |

| | |Heparin |2. After each blood |infusion or pumping device. Use only a Huber |

| | |5 cc of 100 units/cc |sampling or infusion. |non-coring needled for accessing or |

| | | | |heparinizing the catheter. Use only a #20 |

| | |3. Normal Saline-10 cc | |gauge or #22 gauge 1/2-3/4 inch needle. |

| | |Heparin |3. Every 4 weeks if not|Do not allow blood pressures to be taken or |

| | |5 cc of 100 units/cc |being utilized. |blood to be drawn from the arm with the port |

| | | | |except through the port. |

| | | | |For care of the fresh post0op |

| | | | |insertion—follow physician orders |

|Implantable |Port-A-Cath |1. Normal Saline 10cc |1. After each |The port is implanted under the skin in a |

|Infusion Port |Mediport |Heparin |medication and blood |subcutaneous pocket of the upper chest and is|

| |Infuse-A-Port |5cc of 10units/cc |draw. |used for long-term access. All types of |

| |Power Port | | |fluids and medications may be infused. May be|

| | |2. Normal Saline 10cc | |used for blood sampling. Use only a Huber |

| | | |2. Every 4 weeks if not|non-coring needled for accessing or |

| | |Heparin |being utilized |heparinizing the catheter. |

| | |5cc of 100units/cc | | |

| | | | |For care of the fresh post-op |

| | | | |insertion—follow physician orders |

Central Catheters

|NAME OF |BRAND NAME |VOLUME OF |FREQUENCY OF |INDICATIONS |

|CENTRAL CATHETER |OF CATHETER |FLUSH |FLUSH |FOR USE |

|Triple Lumen |Arrow Edwards Abbott |Normal Saline 5cc |1. After each medication |Three types of IV solutions can be given |

| | |in each lumen |administration. |simultaneously without mixing. Can be used |

| |Power TLC |Heparin |2. Every 12 hours if not |for blood sampling. Short-term catheter. |

| | |1cc of 10units/cc |being used for infusion. | |

| | |in each lumen | | |

|Single Lumen |Arrow Cardiosearch |Normal Saline -5cc|Every 12 hours if not being|Single IV therapy |

| | |Heparin |used for infusions. |Short-term catheter. |

| | |1cc of 10units/cc | | |

|Peripherally Inserted |Bard |Normal Saline -5cc|1. Every 12 hours if not |Usually used for therapy that is less than |

|Central Catheter (PICC)|Power PICC |in each lumen |being used. |6 months in duration. |

| | |Heparin |2. After each medication | |

| | |2cc of 100units/cc|administration or blood | |

| | |in each lumen |draw. | |

Tunneled Catheters

|NAME OF |BRAND NAME |VOLUME OF |FREQUENCY OF |INDICATIONS |

|CENTRAL CATHETER |OF CATHETER |FLUSH |FLUSH |FOR USE |

|Cuffed Tunnel |Hickman Broviac |Normal Saline -5cc |1. Every 12 hours if lumen |Long-term catheter for drug and fluid |

|Central Catheter |He Med |each lumen |not being used for infusions.|administration. Available in single or |

| |Power Hickman |Heparin | |double lumen |

| | |5cc of 10units/cc |2. After each medication | |

| | |Heparin |administration or blood draw.| |

| | |5cc of 100units/cc | | |

| | | |3. At the end of therapy | |

|Groshong Single Lumen |Groshong |Normal Saline – 5cc|1. After each medication |Intended for long-term central venous |

|Dual Lumen | |Flush vigorously |and/or solution |access in adults and children. A two-way|

| | | |administration. |valve is located adjacent to the closed |

| | | |2. Once every 7 days when not|distal tip of the catheter, which |

| | | |being used for medications |remains closed when not in use. The |

| | | |and/or solution |valve eliminates the need for clamping |

| | | |administration. |of the catheter. Do not clamp the |

| | | | |catheter. |

|Groshong (cont) | |Normal Saline – |1. After blood sample |Infusion of highly viscous fluids is |

| | |20cc Flush |withdrawal. |accomplished with slight pressure |

| | |vigorously. |2. After blood transfusions. |causing valve to open outwards. Simple |

| | | |3. After infusion of blood |syringe aspiration creates a negative |

| | | |products. |pressure causing the valve to open |

| | | | |inwards to achieve blood withdrawal. |

|Groshong (cont) | |Normal Saline– 30 |1. If blood is observed in | |

| | |cc Flush vigorously|the catheter. | |

| | | |2. Prior to blood sampling | |

| | | |after infusion of TPN | |

| | | |solutions. | |

| | | |NOTE: When irrigating | |

| | | |catheter after blood | |

| | | |sampling, remove injection | |

| | | |cap and connect directly to | |

| | | |catheter connector. | |

Hemodialysis Catheters

| | | | | |

| | | | | |

|NAME OF |BRAND NAME |VOLUME OF |FREQUENCY OF |INDICATIONS |

|CENTRAL CATHETER |OF CATHETER |FLUSH |FLUSH |FOR USE |

|Hemodialysis |Shiley |Hemodialysis RN will |The Hemodialysis RN will |Hemodialysis available in single and |

| | |flush catheter. |flush catheter. |double lumen. |

| | | | | |

| | | | | |

| | |The infusion port is |The infusion port is | |

|Hemodialysis with |Mahurkar |flushed with 5cc of NSS|flushed after each |Triple lumen dialysis catheter with |

|infusion port | |and 1 cc of 10units/cc |intermittent infusion or |third clear port used for infusions. |

| | |Heparin flush by the |every 12 hours if not | |

| | |nurse caring for the |being used. | |

| | |patient. | | |

Approved PNC 4/06, 12/06

Approved Nursing Leadership 4/06, 12/06

Approved Critical Care Committee 4/06, 12/06

Reviewed/Revised 12/06

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