TSM q 7 d

Changing dressings

1 2 3 4 5 6 7

Gauze q 2 d

Changing Sites

2 3normally every 3d

5 6 7Every 7 d c MD order

Changing bags and tubing

2 3normally every 3d

24 hrs

If respiked or meds added outside pharmacy

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Central Venous Catheters

PercutaneousTunneledPICCsImplanted PortsDialysisInsertionMD @ bedside w/x-ray confirmationMD in OR under fluoroscopyMD/trained RN @bedside w/x-ray confirmationMD in OR under fluoroscopy MD in OR under fluoroscopyLocationVisible externally. Enters subclavian, ext. juglar,or int. juglar vein near clavicular areaVisible ext. usually midway bet. clavicle and nipple. Tunneled under skin & threaded through subclavian or IJVisible externally around antecubital fossa, upper arm or neckCompletely internal. Titanium or plastc port is implanted in a surgically created pocket and catheter is threaded into subclavian or int. juglar vein. Access is through skin into self sealing port using special non coring needleVisible externally. Arm or leg placementMaterial/CostPolyurethane$200-$400Silicone$3500-$5000Silicone / polyurethane$350-$500Silicone catheter. Port is titanium or plastic w/self sealing diaphragm$3500-$5000Various materialsLumen2-32-31-21-22-3SuturedYes/entire lifeYes, until internal Dacron cuff healedNo Yes YesDurationShort term 4-10 daysLong termLong termLong termMid termFlushes5-10ml NaCl after use and daily5-10ml NaCl after use and daily5-10ml NaCl after use and daily10ml NaCl followed by 4.5ml heparinized saline (adults-100units/ml; peds-10units/ml) after ea. use or monthly if not accessedDone ONLY by IV team or dialysis nursesBrands/NamesArrow Howe, Triple Lumen, Subclavian, IJHickman, BroviacPICC, PIC, EDPC, Arrow Howe, Gesco, PASVBard, Accces Port-A-CathBard, Tesio, Vescath, QuintonDiscontinueMD or speically trained RN @ bedsideMD in ORSpecially trained RN @ bedsideMD in ORMD in OR

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Central Venous Catheter SitesPICC (Peripherally inserted Central Catheter) Percutaneous(Subclavian)Percutaneous (IJ-Int. Jugular)Tunnelled (Hickman)Implanted Port (single or double lumen)

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CVC Care/Maintenance Flush after each access or daily for catheters>21ga, q 6 hrs

KVO rate:

Adults - 10 ml/hrPediatrics - 2-3 ml/hrNeonates - 0.5-1 ml/hr

Only until rate order received

Verification required for:InsulinHeparinPotassiumDigoxinChemotherapy

LPNs cannot push IV medications

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IV Medication Administration Many medications require patient monitoring that cannot be done on units where the nurse/patient ratios are greater than 1:2

A patient can be moved to a unit where the ratio is appropriate for invasive/frequent monitoring or another nurse can be brought to care for the patient during the med administration

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IV Medication AdministrationSample page from the Pharmacy med administration web site

See APPROVED FOR section. You will find if the medication can be administered on your unit.

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Infusion Nurses Society (INS)

Professional Organization that sets the standards of care for clinicians practicing in the field of infusion therapy.

Standards set by INS are reflected in our policies and procedures related to infusion therapy for health care providers.

In a court of law, the standards set by the INS are used to assess the infusion clinicians performance. www.ins1.org

Show person in classWhy difficult to access elderly patientLaying prone