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. What is the most important action the nurse can take to to protect the patient when administering a medication by IV bolus?CORRECT. Injecting the medication at the prescribed rate is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus, since injecting the medication faster than recommended may result in injury or death.
Which nursing intervention is most important in ensuring safe infusion of a medication?7. Which nursing intervention is most important in ensuring safe infusion of a medication delivered by IV piggyback through a saline lock? Use the most proximal insertion port on the primary tubing.
What is the best way to protect a patient from an IV site injury when giving antibiotic?What is the best way to protect a patient from an IV site injury when giving an antibiotic medication by piggyback? Use a site into which a primary solution is already infusing. Assess the IV site before initiating the IV piggyback medication. Select a relatively small vein to infuse the IV medication.
What is the next step after the IV bolus medication has been administered?(9) After administering the bolus, withdraw the syringe. (10) Clean the injection port with a new antiseptic swab. Allow it to dry. (11) Attach a second syringe containing 0.9% normal saline, and flush the port with 2- 3 mL of normal saline at the same rate at which the medication was delivered.
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