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

2. Content When should IV Resource be called? When should IV Resource be called? Litigation and Incident Reports Litigation and Incident Reports The IV skill level expectations of the student / graduate nurse 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 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) LIP order for PICC ( Peripherally Inserted Central Catheter) Candidate for Midline or PICC Candidate for Midline or PICC Projected IV need for greater than 2 to 3 days Projected IV need for greater than 2 to 3 days Estimated hospital stay of 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 Patient, family or physician request for IV Resource RN Pediatric patient not on a pediatric unit 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 Renal patients who are candidates for dialysis or have hemodialysis lines and have limited vascular access Thrombocytopenia Thrombocytopenia Osmolality of IV fluids > 600mOsm/L, pH outside the range of 6.0-7.5, irritant or vesicant infusions 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 Dressing changes for central venous catheters, PICC and Midlines Implanted vascular device needing access or repair 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. 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. 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. Not a candidate for IVRS referral Immediate need for IV access Less than 24hr stay IV access needed less than 24hrs Preoperative IV placement Primary Nurse- Assess for PIV Placement Primary Nurse attempts PIV Unsuccessful – max 2 attempts Charge Nrs or unit expert attempts (Successful or next step if unsuccessful) Unsuccessful – max 2 attempts Call IVRS with referral Successful PIV Placement

10. Ways to avoid Litigation Document what you see, not what your don’t see Document what you see, not what your don’t see Accurate and complete documentation Accurate and complete documentation Maintain skills and continuously update knowledge Maintain skills and continuously update knowledge Know facility policies and procedures Know facility policies and procedures Know the standards of practice = Infusion Nurse Society published updates January/February 2006 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. 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. Infiltration: Inadvertent administration of nonvesicant medication or solution into the surrounding tissue. Extravasation: Inadvertent administration of vesicant 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 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 Fill out an incident report for a Phlebitis, Infiltration or Extravasation Event Category: Medication Event Category: Medication Event Indicator: Med-IV Injury Event Indicator: Med-IV Injury You will need to indicate what medication caused the phlebitis, infiltration or extravasation You will need to indicate what medication caused the phlebitis, infiltration or extravasation Remember, IV Fluid and Saline flushes are medications Remember, IV Fluid and Saline flushes are medications

13. SN / GN Expectations Most nursing schools are not teaching IV placement 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 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?