IV Therapy Policy Changes Summary for Peds/PICU

1. IV TherapyPolicyChangesSummary for Peds/PICU • IV antibiotics prepared on the unit need to be hung within 1 hour • Chlorhexidine is used for all IV starts • except for infants < 7 days post term • IV tubing is labeled with the date the tubing is to be changed • New labels with the days of the week will replace current labels • Proper technique for central line removal is clarified • See procedure slide • All tubing that is used intermittently (disconnected from the patient at least once a day) must be changed every 24 hours. St Luke's Boise/Meridian IV Therapy Committee

2. IV Policy/Practice UpdateIV TUBING Lines Disconnected Temporarily (main IV or microbore) • Place sterile cap on the end • Do not loop it back on itself and connect to side port • Do not connect it back into itself • No blunt needles • No black stopper from meds • No caps from saline syringes St Luke's Boise/Meridian IV Therapy Committee

3. Parenteral Nutrition Reminders • Parenteral nutrition / lipids should not hang longer than 24 hours. • No filter for parenteral nutrition/ Procalamine ONLY • If lipids added to same line then a 1.2 micron filter is used per floor set-up standards • Any tubing with lipids running through it must be changed every 24 hours. • If parenteral nutrition is non-continuous (e.g. night time only/intermittent), then the tubing is changed daily. • In NICU parenteral nutrition tubing is changed every 24 hours and a 0.2 micron filter is used (Lipids are not filtered) St Luke's Boise/Meridian IV Therapy Committee

4. Removing a Central LineSteps to prevent air embolism • Lay patient flat, as tolerated • Remove old dressing. • Cleanse site with chlorhexidine • Remove sutures or StatLock • Instruct patient to hold their breath, if possible, when line is being pulled • Remove line slowly and steadily while applying pressure at the site • Hold firm steady continuous pressure to the site for 5 minutes • Cover with sterile occlusive, airtight dressing • Maintain for at least 24 hours • Before discarding the line, examine the tip to be sure it is intact. St Luke's Boise/Meridian IV Therapy Committee

5. Look at this picture. What was done correctly? BioPatch was used (blue side or writing up) Dressing is dated and timed Statlock used Catheter is snug as possible to the entrance site, but provides room for a BioPatch Tips for PICC line care If the site is covered by a 2 x 2 or gauze dressing then the dressing needs to be changed every 48 hours. Ideally gauze should not cover the insertion site. The dressing, including the StatLock and BioPatch, needs to be changed every 7 days or more often if soiled Use a central line dressing kit! PICC Dressing St Luke's Boise/Meridian IV Therapy Committee

6. Smart site (C) A negative pressure cap Used for any IV line, central or peripheral Line is clamped as the last ½ ml flush is injected. Caps Microclave (B) • A neutral pressure cap • Used for any IV line, central or peripheral • Line can be clamped at any time during flush Name that cap! CLC2000 (A) • A positive pressure cap • Can be used on central lines • Line is not clamped until flush is completed until the syringe is removed from the cap All caps changed weekly A B C St Luke's Boise/Meridian IV Therapy Committee

7. Power Injectable Port-a-caths Two types of Power Injectable Port-a-Caths • PowerPorts (A) made by Bard • SmartPorts (B) made by Angiodynamics -Allows the use of a power injector by Medical Imaging -Verification required before port can be accessed with a power injectable needle (PowerLoc) or power injected by MI Can Only Be Verified By: • Identification Card carried by the patient Or • Dictated Medical Record from MD who implanted the Port. Report must state it is a power injectable port. St Luke’s Policy Never access a regular port-a-cath with a PowerLoc A B St Luke's Boise/Meridian IV Therapy Committee

8. Discontinue IV for following conditions: Phlebitis – (inflammation of the vein) can be present even in the absence of redness. If the patient persistently complains of pain without redness, discontinuing the IV may be indicated. Infiltration – the inadvertent administration of non-vesicant medication or solution. Extravasation –the inadvertent administration of vesicant or irritating solution. Significant damage may have occurred before you see the outward appearance of necrosis. Inform physician immediately – treatment may be available to minimize damage. Examples would include Wydase and nitro paste. St Luke's Boise/Meridian IV Therapy Committee

9. TKO Guidelines Obtain an MD order with a specific rate when the patient is ready for a “TKO” infusion. The following are guidelines for different ages. • Neonate or infant up to 3 months – 1-5ml/hr • Infants 3 months to 1 yr of age – 5ml/hr • Child from 1 to 6 years of age – 10ml/hr • Child from 6 to 12 years of age – 15ml/hr • Child from 12 to 17 years of age – 20ml/h • Adults - 40ml/hour (~1000ml/24hrs) St Luke's Boise/Meridian IV Therapy Committee

10. Infection Prevention Tips How long do you scrub? 2% chlorhexidine – scrub skin 3.15% chlorhexidine- scrub skin for 30 seconds for 15 secs Multi-dose vials expire 28 days from date opened. Mark with expiration date when first used. If open and not dated, discard. Scrub caps with alcohol for 15 seconds before use. St Luke's Boise/Meridian IV Therapy Committee

11. IV Insertion Tips Reduce fear and encourage cooperation • Prepare the family and child with education regarding procedure, positioning, and pain management techniques • Utilize Child Life when available Obtain supplies for pain-free IV start • J-tip or intradermal buffered lidocaine • 24 % sucrose (Tootsweet) • LMX / EMLA General Tips • Take your time looking for a site • Ask the family if there is a historically good (or bad) site • Wee light and/or VeinViewer may be helpful • Wear snug fitting gloves to avoid contamination of site and to help with assessing the site • Use a warming pack (chemical or blanket from warmer) • Try to position the patient so the site is in a dependent position • With an older child have them pump their fist ~4 times, then hold (not too tight) • Stabilize the vein by pulling the skin taut above or below the entrance site • Insert catheter directly above or to the side of the vein depending on size, location, etc. • When the flashback is seen, pause and advance the catheter, if necessary, to assure that the stylet and catheter tip are in the vein before pushing the catheter off the stylet. • If the catheter won’t advance, try advancing the catheter with the stylet a little more and/or removing the stylet and attaching the t-connector to advance the catheter while flushing. St Luke's Boise/Meridian IV Therapy Committee