1. Carolyn McCune, RN, MSN, CRNP Teresa Peck RN, BSN

2.  Review syllabus and course requirements  Answers any questions related to class  www.emprocedures.com/index.htm www.emprocedures.com/index.htm  Then go to Peripheral IV access

3. 4723.171 Intravenous therapy procedures. (A) A licensed practical nurse may perform on any person any of the intravenous therapy procedures specified in division (B) of this section without receiving authorization to perform intravenous therapy from the board of nursing under section 4723.17 of the Revised Code, if both of the following apply: 4723.17apply (1) The licensed practical nurse acts at the direction of a registered nurse or a licensed physician, dentist, optometrist, or podiatrist and the registered nurse, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication.dentist (2) The licensed practical nurse can demonstrate the knowledge, skills, and ability to perform the procedure safely. (B) The intravenous therapy procedures that a licensed practical nurse may perform pursuant to division (A) of this section are limited to the following: (1) Verification of the type of peripheral intravenous solution being administered; (2) Examination of a peripheral infusion site and the extremity for possible infiltration; (3) Regulation of a peripheral intravenous infusion according to the prescribed flow rate; (4) Discontinuation of a peripheral intravenous device at the appropriate time; (5) Performance of routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion. Effective Date: 04-10-2001

4.  First began in the 17 th century  19 th century-infection control procedures  mid 1950’s-used for surgery and hydration(20%)  Today approximately 90 % of pts in hospital receive IV’s  Skilled nursing homes, doctors office and home

5.  Fluid and electrolyte maintenance, restoration and replacement  Administer medications and nutritional feedings  Give blood and blood products  Chemotherapy  Patient controlled analgesics  KVO for quick access

6.  Oral medications-absorbed in the digestive tract  IV- faster acting and distributed throughout the bloodstream immediately after giving

7.  Unconscious pt:  Unable to swallow:  Vomiting:  Nutrition:  Others?  Slides 3-6-material from Fulcher and Frazier(2007)

8.  Pre-existing vascular compromise  Regional infection

9.  Adult:  Antibiotic:  Arterial Line:  Aspirate:  Central Line:  Central Venous Access Device: (CVAD’S)

12.  Continuous Infusions:  Controlled Analgesic:  Drip Factor:  Electronic Pumps and Controllers:  Flow Rate:ml/hr or gtts/min  Infiltration:  Infusion Devices:

13.  Thru peripheral IV sites-depend on gravity for administration- must be 24-36 inches above IV sites  If patient changes positions volume decreases-back pressure greater, rate slows or stops  Simplest controllers-roller or slide clamp  Use to speed up or slow, counts gtts in drip chamber

14.  Apply external pressure to administration set tubing to run at specified rate  Specific volume/time  More accurate  Alarm systems-kinks, air, occlusion  Disadvantage-Cost of equipment, maintenance, more serious infiltration.

16.  SYRINGE PUMPS  Holds prefilled syringe  Positive pressure to plunger delivers specific volume  Used for small volume  Insulin pumps, PCA pumps  Safer, preprogramming to prevent calculator errors

17.  Initiate:  Intermittent Infusion: (Piggyback)  Intravenous: (IV)  IV Bolus:  IV Push:  Maintain

18.  Nurse Practice Act: (Ohio)  Palpation:  Peripheral:  Peripherally Inserted Central Catheters: (PICC’s)  Phlebitis:

19.  Piggyback:  Roller clamp:  Tourniquet:  TPN:  Transparent Dressing:  Venipuncture:  Other Terms:  Questions????????

20.  Apparatus that connects large volume parenteral solution with IV access device into patient veins  Insertion spikes  Clip chamber  Plastic tubing with rate control clamp  Rubber injection port  Needle adapter and protective cap on needle adapter

23.  Over needle cath left in for medical administration  Flush every 8 hours  Flush before/after meds

25.  See Handout from OBN website  Chapter 4723-17  Try to access sites