iv tips second year ppt

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IV Therapy January,‘08

Tip of the Month

© OHSU IV Therapy Team.

Contact: [email protected]

EveryHubEveryTime E

veryHubEvery

Time

• No matter what the occasion,SCRUB the catheter ports everysingle time before access.

• Evidence Supports SCRUBBING

using pressure and friction for 15seconds with alcohol and allowto dry.*

• *Kaler, Wendy; Chinn, Raymond (2007) Successful Disinfection of Needleless Access Ports: A Matter of Time and Friction. Journal of the Association for Vascular Access, Volume 12, Number 3, pp. 140-142

•

OHSU Scrub The Hub OHSU Scrub The Hub m i nCam ai n

JOIN JOIN

TODAY TODAY

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m i n

IV Therapy February,‘08

Tip of the Month



All Newly Placed Central Venous Access Lines

(CVC, PICC, Hickman, and Port) Absolutely Require NEW Infusion Bags and Tubing.

Prevent Central Venous Access Bloodstream Infections Prevent Central Venous Access Bloodstream Infections

New LineNew LineNew Tubing New Tubing

In cases of emergent Central Venous Access replacement

Old infusions can be switched to new central line without new bags/tubing.

The old infusions should bereplaced with new infusionsand tubing as soon as the patient is

stable.

OHSU Policy: Continuous Infusion BagAnd tubing change With Central Line

ReplacementEffective Date: February 01, 2006



IV Therapy March Tip of The

Month



BIOPATCH® Protective Disk has been found to reduce theincidence of CRBSI and local infections.

Use BIOPATCH with Central Venous Catheters*

Watch for brief unit inservices in March

BIOPATCH BIOPATCH

New Central Venous Access Dressing

ChangeRequirements:Once every seven

days with Biopatchunless integrity of the

dressing is compromised.

New central venousdressing kits coming also !

®

* Exclude patients with Chlorhexidine sensitivity

IMPORTANT: Read Tip of The Month e-mail.



Upon admission1.Ask patient or family member if Portacath present.2.Assess chest for any vascular access

•Palpate chest for implanted port

•Take a look at patient history, especially if they have achronic illness3.Look at the CXR4.If they have a port, obtain order for access from provider 5.Page your IV Therapy Team for access

…

.Your patient may already have a port

heck and ask

to

save your patient unnecessary line placements and additional

“Nobody checked and nobodyasked”

V T h e r a p y

, ‘a y 0 8 i p o f t h eM o n t h

Does your patient have aPortacath?

R e m e m

b e r

t o

C h

ec

k

a n

d

A s

k



e e p P I C C i n e s…l o w i n g

~ ~l u s h

•

o F l u s h

o F l o w

r e v e n t a s c u l a r

c c e s s

n f e c t i o n n d

.c c l u s i o n

Flush every eight hours using

pulsatile flush

pen Ended PICC Flush( )uch as a Power PICC

:dult 10 mL NS pulsatileflush

- /followed with 3 5 mL 10 units mLHepar in :eds -5 10 mL NS pulsatile flush

- /followed with 3 5 mL 10 units mLHepar in

very 8 hrs and after each use

To Prevent Occlusion Avoid this Open the flow

IV Therapy,June 2008

Tip of the Month

. © OHSU IV Therapy Team: .Contact Spiering@ohsu edu

R e m i n d e r e p a r i n w i l l n o t

i s s o l v e x i s t i n g c l o t s

Pulsatile flush each lumen with 10 mL

Normal Saline f i r s t ,-then instill 3 5 mL

/ .10 units mL Heparin



Max-Plus Clear Valves/Hub Quick List

1. Wash your hands prior to touching any part of the hub.

2. Invert the MaxPlus Clear and prime beforeattaching to end of a catheter or tubing.

3. “Scrub the Hub” with friction for 15 seconds prior

to entry.4. Replace the MaxPlus Clear After blood

draws/administration or if blood residue ispresent in the valve.

5. Flush through the hub with 10mL Normal Saline(Use Heparin per flush protocol) and assure hubis clear of all blood residue.

6. When clamping a line, only clamp after flush iscomplete and you have disconnected fromMaxPlus Clear. This ensures blood is clearedfrom the end of the catheter.

7.

8.

1.

Hub Facts-Hubs are easily contaminated whenthey touch the skin.

-If hubs are not disinfected thecontaminate can infuse into the valveand patient.

-Residual blood in the hub serve as amedia for infection.--Clear hubs allows you to seeresidual blood and drugincompatibility precipitant in the hubso you can replace them and decrease

the risk of Catheter Associated BloodStream Infection.

--Reference: Royer, Tim et al(2007) A Five-FoldDecrease of Intravascular Catheter Associated BloodStream Infections: Clearly Beyond the Central LineBundle-

IV Therapy July Tip of TheMonth

A Clear Viewcoming to you soon…MaxPlus Clear

Brief 5 minuteinserviceson your unit

the week of July 23rd

To Clear

From Opaque



Firs t Assess for external

mechanical obstructions

(all

which can contribute to catheter)clottingØ IV tubing clamped?Ø Pump off ?Ø Infusion set empty?Ø Patient position cause kinking?Ø Dressing wet due to break or hole

.in catheterØ :For Ports Check Huber needle

placement

1.2.

1.

ThenAssess for internal obstruction•Remove and inspect valves & tubing•Place 10mL Normal Saline syringe to hub•Attempt to Withdraw 1 st and assess for bloodreturn. Able to infuse? Sluggish? Completelyoccluded?

Assess EACH LUMEN separately

Never leave one clotted lumen

IV Therapy August

Tip of The Month

Central VenousCatheter

Occlusion

After full inspection and confirmation of a catheter occlusion, call IV Therapy andreport your findings

Catheter Occlusion = Risk of infection and venous thrombosis

Immediate Action Required

Reference: Nakazawa, Nadine (2008) Managing Catheter Occlusions with Cathflo. Presentation



AVOID COMPLICATIONS, STOP THEINFUSION!

•“

IF IT’S RED IT’S DEAD•IF IT’S SORE….NO MORE ”

• IV THERAPY SEPTEMBER

• TIP OF THE MONTH

P h l e b i t i s S u s p e c t e d ? § D I S C O N T I N U E I N F U S I O N ! § R e m o v e C a t h e t e r § D i s i n f e c t v e n i p u n c t u r e s i t e § A p p l y p r e s s u r e a t r e m o v a l s i t e t o p r e v e n t

b l e e d i n g § E l e v a t e e x t r e m i t y § A p p l y i n t e r m i t t e n t w a r m , m o i s t h e a t f o r 2 0 m i n .

3 - 4 t i m e s p e r d a y . q q q q

q q q q q

q

Phlebitis or Inflammation of the Vein§§Pain with flushing or palpation of site§Edema§Erythema or red streak over vein§Palpable firmness of vein§••••••••



iv tips second year ppt

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