LHS IV Resource

1. LHS IV Resource January 2008 PCM Presentation Jacqueline Bowns RN IVRS/WOCN Supervisor

2. Content • When should IV Resource be called? • Litigation and Incident Reports • The IV skill level expectations of the student / graduate nurse

3. IV Resource Consult • Please review IV Complex Identifier for contacting IV Resource Nurse LHS.900.4505

4. Criteria For Referral • PIV restart during current hospitalization after a maximum of 2 unsuccessful attempts by patient care nurse, charge nurse or unit expert • LIP order for PICC (Peripherally Inserted Central Catheter) • Candidate for Midline or PICC • Projected IV need for greater than 2 to 3 days • Estimated hospital stay of greater than 2 to 3 days • Patient, family or physician request for IV Resource RN • Pediatric patient not on a pediatric unit

5. Criteria For Referral • Renal patients who are candidates for dialysis or have hemodialysis lines and have limited vascular access • Thrombocytopenia • Osmolality of IV fluids > 600mOsm/L, pH outside the range of 6.0-7.5, irritant or vesicant infusions • Dressing changes for central venous catheters, PICC and Midlines • Implanted vascular device needing access or repair

6. Things to Remember • Leave a detailed message on voice mail . The IV nurse can better prioritize the workload if they know the who’s, what’s, where’s, why’s and when’s. • Don’t worry if you haven’t received a call back from the IV Nurse. They receive multiple calls/requests and are continually prioritizing workload.

7. PIV Algorithm PIV Placement / Replacement Primary Nurse- Assess for PIV Placement

8. PIV Placement / Replacement Primary Nurse- Assess for PIV Placement Candidate for IVRS referral Refer to IVRS complex ID Call IVRS with referral

9. Primary Nurse- Assess for PIV Placement • Not a candidate for IVRS referral • Immediate need for IV access • Less than 24hr stay • IV access needed less than 24hrs • Preoperative IV placement Successful PIV Placement Primary Nurse attempts PIV Unsuccessful – max 2 attempts Unsuccessful – max 2 attempts Charge Nrs or unit expert attempts (Successful or next step if unsuccessful) Call IVRS with referral

10. Ways to avoid Litigation • Document what you see, not what your don’t see • Accurate and complete documentation • Maintain skills and continuously update knowledge • Know facility policies and procedures • Know the standards of practice = Infusion Nurse Society published updates January/February 2006

11. Common issues in IV therapy litigation • Nerve injuries: Most common is injury to distal portion of the radial nerve, just above the thumb. • Infiltration: Inadvertent administration of nonvesicant medication or solution into the surrounding tissue. • Extravasation: Inadvertent administration of vesicant medication or solution into the surrounding tissue • Phlebitis/thrombophlebitis: Inflammation of the vein. Promethazine (Phenergan) is a major cause of this problem Legal Aspects of Infusion Therapy – Marva Petty MSN, RN, LNCC The Medical Resource Network, Inc. LCC INS Annual Fall Seminar October 2007

12. REPORT IT! • Fill out an incident report for a Phlebitis, Infiltration or Extravasation • Event Category: Medication • Event Indicator: Med-IV Injury • You will need to indicate what medication caused the phlebitis, infiltration or extravasation • Remember, IV Fluid and Saline flushes are medications

13. SN / GN Expectations • Most nursing schools are not teaching IV placement • A nursing student or graduate nurse can attempt vascular access with an LHS preceptor who has demonstrated competency in vascular access • Not mandatory to take the basic adult IV class • Have 3 successful PIV placements observed by IVRS OR another nurse who has competency in PIV placement

14. Remember – You are never stranded, there is always help available…Questions?