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Carolyn McCune, RN, MSN, CRNP Teresa Peck RN, BSN

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Text of Carolyn McCune, RN, MSN, CRNP Teresa Peck RN, BSN

  • Carolyn McCune, RN, MSN, CRNPTeresa Peck RN, BSN

  • Review syllabus and course requirementsAnswers any questions related to classwww.emprocedures.com/index.htmThen go to Peripheral IV access

  • 4723.171 Intravenous therapy procedures.(A) A licensed practical nurse may perform on any person any of the intravenous therapy procedures specified in division (B) of this section without receiving authorization to perform intravenous therapy from the board of nursing under section 4723.17 of the Revised Code, if both of the following apply:(1) The licensed practical nurse acts at the direction of a registered nurse or a licensed physician, dentist, optometrist, or podiatrist and the registered nurse, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication.(2) The licensed practical nurse can demonstrate the knowledge, skills, and ability to perform the procedure safely.(B) The intravenous therapy procedures that a licensed practical nurse may perform pursuant to division (A) of this section are limited to the following:(1) Verification of the type of peripheral intravenous solution being administered;(2) Examination of a peripheral infusion site and the extremity for possible infiltration;(3) Regulation of a peripheral intravenous infusion according to the prescribed flow rate;(4) Discontinuation of a peripheral intravenous device at the appropriate time;(5) Performance of routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion.Effective Date: 04-10-2001

  • First began in the 17th century19th century-infection control proceduresmid 1950s-used for surgery and hydration(20%)Today approximately 90 % of pts in hospital receive IVsSkilled nursing homes, doctors office and home

  • Fluid and electrolyte maintenance, restoration and replacementAdminister medications and nutritional feedingsGive blood and blood productsChemotherapyPatient controlled analgesicsKVO for quick access

  • Oral medications-absorbed in the digestive tractIV- faster acting and distributed throughout the bloodstream immediately after giving

  • Unconscious pt:Unable to swallow:Vomiting:Nutrition:Others?

    Slides 3-6-material from Fulcher and Frazier(2007)

  • Pre-existing vascular compromiseRegional infection

  • Adult:Antibiotic:Arterial Line:Aspirate:Central Line:Central Venous Access Device: (CVADS)

  • Continuous Infusions:Controlled Analgesic:Drip Factor:Electronic Pumps and Controllers:Flow Rate:ml/hr or gtts/minInfiltration:Infusion Devices:

  • Thru peripheral IV sites-depend on gravity for administration- must be 24-36 inches above IV sitesIf patient changes positions volume decreases-back pressure greater, rate slows or stopsSimplest controllers-roller or slide clampUse to speed up or slow, counts gtts in drip chamber

  • Apply external pressure to administration set tubing to run at specified rateSpecific volume/timeMore accurateAlarm systems-kinks, air, occlusionDisadvantage-Cost of equipment, maintenance, more serious infiltration.

  • SYRINGE PUMPSHolds prefilled syringePositive pressure to plunger delivers specific volumeUsed for small volumeInsulin pumps, PCA pumpsSafer, preprogramming to prevent calculator errors

  • Initiate:Intermittent Infusion: (Piggyback)Intravenous: (IV)IV Bolus:IV Push:Maintain

  • Nurse Practice Act: (Ohio)Palpation:Peripheral:Peripherally Inserted Central Catheters: (PICCs)Phlebitis:

  • Piggyback:Roller clamp:Tourniquet:TPN:Transparent Dressing:Venipuncture:Other Terms: Questions????????

  • Apparatus that connects large volume parenteral solution with IV access device into patient veinsInsertion spikesClip chamberPlastic tubing with rate control clampRubber injection portNeedle adapter and protective cap on needle adapter

  • Over needle cath left in for medical administrationFlush every 8 hoursFlush before/after meds

  • See Handout from OBN websiteChapter 4723-17

    Try to access sites

    Mastectomy, lymph node resetion, AV fistula,thrombosis

    Cellulitis of extremity

    *Adult-18 years of age or olderAntibiotic-medication, including an anti-infective or antifungal, administered to prevent or treat infectious diseaseCan only do VENOUS access as LPNAspirate-pull back on syringe to look for blood

    Central lines-IndwellingUsed for large volumes, irritating medications and solutions like TPNWhen peripheral sites are exhaustedVein access is poorLong term home therapyMost common sites-Subclavian, Jugular3 types insertion, CVC,PICCInserted into sup vena cava or just outside Rt atrium via cephalic14-28 gageSingle or double Thrombosis, hemothorax, Cost less than othersShould not draw blood, give TPN1-3 months in place, lasts for a yearFlushed and capped when not in use*Will see these-CAN DO DRESSING CHANGES. Cannot hang fluids, change rate, flush, or anything else*Controlled analgesics-PCA Pumps

    Drip factor-how many drops make up 1 ml of fluid. Depends on diameter of tube (think turkey baster vs eye dropper

    Infusion devices-Created for more accurate control-heparin and dopaminePrevention of overdosing-toxicity-amino glycosides to prevent nephrotoxicityClassified as controllers; pumps and syringe pumps

    *Initiate-means to start or beginPiggyback means an intermittent or secondary IV infusionMaintain-means to administer or regulate an intravenous infusion according to the prescribed flow rate*www. Nursing.ohio.govLaws and Rules-4723-17 Intravenous Therapy*

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