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NUR 141: SKILL 28-5: CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING

NUR 141: SKILL 28-5: CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING. CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING - INTRODUCTION. Administration of solutions via the parenteral route is not without complications, which can be either systemic or local.

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NUR 141: SKILL 28-5: CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING

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  1. NUR 141: SKILL 28-5: CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING

  2. CHANGING A SHORT PERIPHERAL INTRAVENOUS DRESSING - INTRODUCTION • Administration of solutions via the parenteral route is not without complications, which can be either systemic or local. • Systemic complications occur within the vascular system and are usually remote to the infusion site (e.g., septicemia, circulatory overload, and embolism). • Local complications result from trauma to the inner layer of the vein (tunica intima) as a direct result of many factors such as poor insertion technique, inappropriate size of short peripheral device, infusing a solution or medication with a pH or osmolarity not within required ranges, and poor assessment and incorrect technique for short peripheral dressing changes.

  3. INTRODUCTION – CONT’D • Short peripheral intravenous (IV) catheters require strict adherence to infection-prevention measures to avoid complications associated with these devices. • The skin insertion site is the most common source of colonization and infection for IV catheters. Therefore you need to securely apply catheter dressings and change dressings when wet, soiled, or loosened. • You may stabilize short peripheral IV catheters with a manufactured stabilization device, sterile tapes, or surgical strips and cover the site with a transparent semipermeable membrane (TSM) dressing or sterile gauze. • You change a transparent dressing during catheter site rotation of a short peripheral device and immediately if integrity of the dressing is compromised.

  4. INTRODUCTION – CONT’D • Change gauze dressings every 48 hours and immediately if integrity is compromised. When using gauze under a transparent dressing (although not recommended), it is considered a gauze dressing and should be changed every 48 hours.

  5. ASSESSMENT • 1. Determine when the dressing was last changed. Dressing should be labeled to include date and time applied, size and type of venous access device (VAD), and date VAD was inserted. • 2. Perform hand hygiene. Observe present dressing for moisture and intactness. Determine if moisture is from site leakage or external source. • 3. Observe IV system for proper functioning or complications (e.g., current flow rate, tugging, or catheter kinks). Palpate catheter site through intact dressing for complaints of tenderness, pain or burning (Note: apply clean gloves if gauze dressing is moist). • 4. Monitor body temperature • 5. Assess patient’s understanding of need for continued IV infusion

  6. PLANNING • 1. Expected outcomes following completion of the procedure: • IV insertion site remains free of IV-related complications (redness, swelling, tenderness, or exudate) – As proper care maintains the IV site. • Patient and family caregiver can explain procedure and purpose of VAD dressing change – This demonstrates learning.

  7. IMPLEMENTATION • 1. Explain the procedure and purpose to patient and family caregiver. Explain that the patient will need to hold affected extremity still. Explain how long procedure will take. • 2. Perform hand hygiene. Collect equipment. Apply clean gloves. • 3. Identify the patient using two identifiers.

  8. IMPLEMENTATION – CONT’D • 4. Remove the dressing: • For transparent semipermeable dressing: Remove by pulling up one corner and pulling side laterally while holding catheter hub with non-dominant hand. Repeat on other side. Leave tape or catheter stabilization device that secures IC catheter in place. • For gauze dressing: Stabilize catheter hub while loosening tape and removing old dressing one layer at a time by pulling toward the insertion site. Leave the tape that secure VAD to skin intact. Be cautious if IV tubing becomes tangled between two layers of the dressing.

  9. IMPLEMENTATION – CONT’D • 5. Observe insertion site for signs and symptoms of IV-related complications (tenderness, redness, swelling, exudate, or complaints of pain). If complication exists or if ordered by health care provider, discontinue infusion. • 6. Prepare new sterile tape strips for use. If IV is infusing properly, gently remove tape or stabilization device securing VAD. Stabilize VAD with one finger. Use adhesive remover to clean skin and remove adhesive residue if necessary. • Clinical Decision Point: Keep one finger over catheter at all times until tape or dressing secures placement. If patient is restless or uncooperative, it is helpful to have another staff member help with procedure.

  10. IMPLENTATION – CONT’D • 7. While stabilizing IV, clean insertion site with chlorhexidineantiseptic swab, using friction vertically and horizontally and moving from insertion site outward with a third swab. Allow antiseptic solution to dry completely. • 8.Optional: Apply skin protectant solution to area where you will apply tape or dressing. Allow to dry. • 9. While securing catheter, apply a sterile dressing over site (procedures differ; follow agency policy). • A. Manufactured catheter stabilization device: apply catheter stabilization device as directed in SKILL 28-1, step 23 A. • B. Transparent Dressing: Apply transparent dressing as directed in Skill 28-1, step 23 B • C. Sterile Gauze Dressing: Apply sterile gauze dressing as directed in Skill 28-1, Step 23 C • 10. Remove and discard your gloves. • 11. Optional: Apply site protection device (e.g., I.V. House Ultra Protective Dressing).

  11. IMPLEMENTATION – CONT’D • 12. Anchor IV tubing with additional pieces of tape, if necessary. When using transparent dressing, avoid placing tape over the dressing. • 13. Label dressing per agency policy. Information on label includes date and time of IV insertion, VAD gauge size and length, and your initials. • 14. Discard equipment and perform hand hygiene.

  12. EVALUATION • 1. Observe function, patency of IV system, and flow rate after changing dressing. • Validates that IV is patent and functioning correctly. Manipulation of Catheter and tubing will affect rate of the infusion. • Inspect condition of short peripheral site for signs & symptoms of IV-related complications (e.g., redness, complaints of pain, swelling, or exudate.) • Complications such as phlebitis and infiltration require removal of short peripheral catheter and insertion of a new catheter at the new site above the area of complication or other extremity. • Monitor patient’s body temperature. • Elevated temperature indicates infection that can be associated with contamination of venipuncture site or septicemia.

  13. UNEXPECTED OUTCOMES • 1. Short peripheral catheter is infiltrated, as evidenced by decreased flow rate or edema, pallor, or decreased temperature around the insertion site. • Stop the infusion and remove the catheter. • Restart new short peripheral catheter in other extremity or above previous insertion site if continued therapy is necessary. • 2. Phlebitis is present • Stop the infusion and remove the short peripheral catheter. • Restart new catheter in other extremity if continued therapy is necessary. • 3. Short peripheral catheter is accidentally removed or dislodged. • Restart new short peripheral catheter if continued therapy is needed.

  14. UNEXPECTED OUTCOMES – CONT’D • 4. Patient has an elevated temperature. • Notify health care provider • Prepare to obtain blood culture or culture of IV site to evaluate the source of the infection • 5. Insertion site is red, edematous, and/or painful and/or has presence of exudate, indicating infection at venipuncture site. • Notify health care provider. Culture of catheter tip and/or exudate may be ordered (confirm before removal of IV) • Remove short peripheral catheter (see procedural guideline 28-1)

  15. RECORDING & REPORTING • Record time short peripheral dressing was changed, reason for change, type of dressing material used, patency of system, and description of venipuncture site. • Report to nurse in charge or oncoming nursing shift that dressing was changed and any significant information about integrity of system. • Report to health care provider and document any complications.

  16. END OF SKILL • This is the end of the skill. • Your book has not provided a video for this skill. • I have found one for you, on You-tube, but please remember I am not affiliated with the school, so please feel free to watch the video, but you must follow the protocol for this skill by following your book’s instructions. • Remember, for all videos, just copy the link and paste it. • VIDEO • 3.2 Changing a Peripheral IV dressing • http://www.youtube.com/watch?v=SSVJO0DwtGI • You will need to go into the skills lab and practice in order to pass this skill • Good Luck!

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