Transcript LHS IV Resource Department

LHS IV Resource
January 2008 PCM Presentation
Jacqueline Bowns RN IVRS/WOCN Supervisor
Content
• When should IV Resource be called?
• Litigation and Incident Reports
• The IV skill level expectations of the student /
graduate nurse
IV Resource Consult
Please review IV Complex Identifier for contacting
IV Resource Nurse LHS.900.4505
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
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
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.
PIV Algorithm
PIV Placement / Replacement
Primary Nurse- Assess for PIV
Placement
PIV Placement / Replacement
Primary Nurse- Assess for PIV
Placement
Candidate for IVRS referral
Refer to IVRS complex ID
Call IVRS with referral
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
Unsuccessful – max 2 attempts
Primary Nurse attempts PIV
Unsuccessful – max 2 attempts
Charge Nrs or unit expert
attempts (Successful or next step if
Call IVRS with referral
unsuccessful)
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
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
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
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
Remember – You are never stranded, there is always help available…
Questions?