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20180129

page

100

UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Cardiovascular and Infusion

Continuous Peripheral Intravenous Therapy (Adult and Pediatric) (1.23AP)

Continuous Peripheral Intravenous Therapy (Adult and Pediatric) (1.23AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.23AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
December 26, 2016
Amended:
Dec.29, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.23AP

Original
Revision

Page
1
of 12

Title: Continuous Peripheral Intravenous
Therapy (Adult & Pediatric) (Inpatient and
Ambulatory)

I. PURPOSE

To define policies and procedures related to peripheral intravenous access and intravenous (IV)
therapy, including intravascular access for administration of fluids, blood, nutrients and
medication; and site care, dressing change and removal.

For administration of chemotherapy, refer to Policy 10.28AP, Chemotherapy Competence for
Nurses (Adult & Pediatric)

II. POLICY

A. Peripheral intravenous catheters (PIV) can be inserted by a 1) qualified Registered Nurse
(RN), 2) Technician, or 3) Licensed Practical Nurse (LPN). RN placement of catheters
greater than four (4) inches requires additional training and qualification.
B. A qualified RN, LPN or Technician may cap off a peripherally inserted venous catheter.
C. Use pre-filled normal saline syringes dispensed by pharmacy for flushing and/or locking
PIV catheters.
D. Hand hygiene should be performed when indicated according to UW Health Clinical Policy
4.1.13, Hand Hygiene.
E. Exam gloves are to be worn by all personnel manipulating vascular devices and apparatus.
F. PIV catheter sites are to be inspected at least once every four (4) hours, but more frequently
during rapid infusions or when infusing medications with potential for extravasation.
Assess PIV site for signs of infection (i.e., warmth, erythema, drainage), infiltration,
palpate for pain or tenderness and ensure dressing is dry and intact. For pediatric patients
more frequent assessment may be required (refer to section VII, A, 4)
G. Emergently Placed PIVs: Replace PIV catheters within 24 hours if inserted under
emergency conditions (paramedic IV). If outside hospital PIV was placed in controlled
circumstances (not emergent), and it meets our site criteria, then it may stay in for 72 hours.

III. TABLE OF CONTENTS

A. Procedure - Preparation for PIV Insertion
B. Procedure -PIV Insertion
C. Procedure – Initiate Infusion
D. PIV Assessment
E. PIV Maintenance And Discontinuation
F. UW Health Cross References
G. References

Page 2 of 12


IV. PROCEDURE – PREPARATION FOR PIV INSERTION

A. Gather Equipment
• Gloves (to be worn by all personnel starting or discontinuing PIV)
• Lidocaine 1% without epinephrine injection or topical anesthetic (4% lidocaine
ointment L.M.X.4) or Bacteriostatic 0.9% sodium chloride vial, and 29-31 gauge
safety syringe
• Intravenous administration set
• Intravenous solution as prescribed
• 10 mL normal saline syringe
• Extension set with needleless connector
• Choice of safety catheter and gauge
• IV start kit with chlorhexidine sponge (ChloraPrep
®
)
• Sterile alcohol prep swabs
• Tubing change date labels
• Transparent dressing; Tegaderm
TM
Advanced Securement Dressing for adult
patients keeping IV in greater than 24 hours
• StatLock
®
or other manufacturer’s securement device for pediatric patients as
appropriate

Optional:

• Infusion pump
• Arm board
• Underpad
• Dead end cap (for distal tip on tubing)
• 0.2 micron air filters for patients with congenital heart defects
• Povodine Iodine or Alcohol for CHG allergy
• Distraction tools (i.e. Buzzy)

B. Education
1. Prepare patient/family for PIV placement.
2. Explain reason for PIV placement
C. Site Selection
1. Assess patient's condition, vein condition, age, medication and duration of therapy.
2. Examine extremities for most appropriate location for PIV access. In general, do
not use lower extremities for peripheral venous access.
a. Start routine peripheral IV therapy in distal areas of the upper extremities;
hands and lower arms are preferred sites for PIV access unless therapeutic
infusate poses a potential extravasation risk. If so, the preferred PIV
placement of PIV is in the upper arm.
b. Always assess distal to proximal and use the most distal vein appropriate
for therapy required. Subsequent venipunctures may be made in areas
proximal to previous PIV sites, as necessary.
c. Avoid the antecubital fossa since this is the preferred site for venipuncture
for drawing blood tests and has a higher incidence of mechanical
complications (occlusion/phlebitis).

Page 3 of 12

d. Adults: Do not use feet for PIV access if patient is diabetic or if patient
has compromised circulation in the lower extremities.
e. Pediatric Patients:
i. For non-ambulatory pediatric patients the foot/ankle may be used
for PIV access if necessary.
ii. Scalp veins may be used if necessary. Clip/trim hair at scalp
venipuncture site and offer to save for family.
f. Avoid previously used veins, injured veins, and sclerotic veins. Avoid
areas of flexion unless the joint is immobilized with an armboard or
similar device. Select alternate arm/site for patients who have undergone
breast surgery/mastectomy or who have an existing fistulated access.
3. Palpate a vein to differentiate from an artery.
D. Premedicate for analgesia according to Delegation Protocol 29, Analgesic Ordering Prior
to Needle Insertion
1. Use appropriate premedication prior to PIV insertion based on urgency of
peripheral vascular access and patient’s developmental level by selecting (a)
topical L.M.X.4, (b) bacteriostatic saline, or (c)intradermal lidocaine.

E. Prepare Infusion
1. Check the provider's order for prescribed solution, volume, additives, and rate of
flow.
2. Determine if patient has any allergies (sensitivities) to medication, tape, Tegaderm,
lidocaine, etc.
3. Obtain prescribed solution and check against provider’s order.
4. Connect administration set to solution container and retain protective cap at distal
end. Open clamp and flush tubing with solution according to manufacturer's
instruction; clamp tubing and replace with the protective cap.
5. Affix appropriate date label to tubing.
6. For adult and pediatric patients with congenital heart disease with right to left
shunt contact provider to determine if air filter is required on IV tubing. If a filter
is required:
a. Filter placement should be between the last flush site and patient PIV
access site.
b. These filters cannot be used with blood, lipids or propofol.
F. Prepare for Venipuncture
1. Choose appropriate catheter gauge.
a. Choose the smallest gauge catheter possible to achieve the ordered
therapy. Routine IV fluids and medications may be administered through a
22-gauge or 24-gauge catheter. Blood transfusions may be given through a
22-gauge for patients with small veins.


L.M.X.4 Bacteriostatic 0.9%
sodium chloride
Lidocaine 1% (without
epinephrine)
Delivery of agent Topical Intradermal Wheel Intradermal Wheel
Location of agent Accudose Central Supply Room Accudose
Multi-patient use No Yes Yes
Time needed for full
effect
20-30 minutes Immediate Immediate
Supplies needed for
delivery
Tegaderm 29-30G Safety Syringe 29-30G Safety Syringe

Page 4 of 12

b. Choose a larger gauge catheter for persons receiving rapid infusion of
blood and fluids during surgery or in case of trauma.
c. Adults: Consider midline intravascular catheter if patient:
i. Will be hospitalized > 5 days
ii. May require intravenous therapy for prolonged inpatient stay (up
to 29 days)
iii. Has poor vascular access which may require repeated PIV
placement
2. Assemble equipment.
3. Place underpad under selected extremity.
4. Clip or trim excessive hair, if indicated. Hair should not be shaved as this can
cause abrasions, which increase the risk of infection.
5. Pediatric considerations:
a. The nurse should have a knowledge and understanding of growth and
development, including the psychological and behavioral development
relative to the patient's age group and cognitive level.
b. For the pediatric population, notify a Child Life Specialist (CLS) prior to
PIV start to discuss support and distraction options with the patient and
family. Whenever physically possible, pediatric patients should be taken
to the procedure room to perform any painful or potentially painful
procedures.
c. Use some type of premedication and distraction to start PIV. Refer to
AFCH/Pediatric Resources: Topical Lidocaine.
d. Whenever physically possible, starting a PIV or any other painful
procedure should occur in the procedure room and with the assistance of a
CLS.
e. Observe PIV site frequently. The pediatric patient may be at greater risk
for potential complications related to infusion therapy and thus requires
more frequent monitoring.
f. If the PIV attempt is unsuccessful, see Pediatric Vascular Access
Algorithm (in Related Resources) for guidance on next steps to follow.

V. PROCEDURE – PIV INSERTION

A. Skin Preparation
1. Prepare the skin using Chlorhexidine solution. Use povidone iodine solution for
skin disinfection for patients with sensitivity to chlorhexidine
a. Perform friction scrub for 30 seconds. Allow to dry 30 seconds. For
patients less than 48 weeks corrected age, wipe chlorhexidine from skin
with sterile saline wipe or sterile saline gauze and allow to dry prior to
insertion of catheter.
b. Do not touch the puncture site after disinfecting the area unless wearing
sterile gloves. Palpation of the vessel should be done before prepping.
B. Catheter Insertion
1. Distend vein by applying tourniquet or blood pressure cuff 4-6 inches above site
selected.
a. Tourniquet may not be necessary for distended veins or for elderly
patients.
b. Additional measures utilized to distend veins include:

Page 5 of 12

i. Have the patient open and close the fist repeatedly.
ii. Lightly stroke directly over a vein in an upward direction toward
the tourniquet.
iii. Lower the extremity for five (5) minutes before applying
tourniquet.
iv. Wrap the entire extremity in warm, moist towel, or have patient
put arm under warm running water before applying tourniquet.
v. With difficult peripheral venous access, a blood pressure cuff
inflated to just below the diastolic pressure may help to distend the
vein.
2. Directions for Insertion using BD Insyte
TM
Autoguard
TM
IV Catheter
a. Remove needle cover in a straight outward motion and inspect catheter
unit. Rotate catheter to loosen seal.
b. Perform venipuncture. Approach vein slowly at a low angle. Observe
flashback.
c. Lower and observe catheter until 1/8 inch advanced to ensure full
vein entry.
d. Holding the flash chamber stationary, advance the catheter off the needle
into the vein while maintaining skin traction.
e. Release tourniquet, apply digital pressure beyond catheter tip, and depress
button to retract needle.
f. Attach primed extension set with needleless connector

to BD Insyte
TM
Autoguard
TM
IV catheter.
3. Directions for Insertion using BD Saf-T-Intima
TM
IV Catheter
a. Remove needle cover and inspect unit. Make sure needle bevel is facing
up.
b. Grasp pebbled side of wings, pinching firmly (pebbles to fingertips).
c. Approach vein slowly at a low angle.
d. Observe flashback in tubing behind wings.
e. Upon flashback visualization, lower catheter almost parallel to the skin.
Thread entire unit an additional 1/8 inch to ensure catheter tip is in the
vein.
f. Release wings and stabilize.
g. Hold one (1) wing on top and bottom. Grasp white shield by pebbles and
pull straight back until needle is safely shielded. Do not stop until needle
is all the way into the safety shield. Shield will come off, exposing the
adapter.
h. Thread catheter into vein while maintaining skin traction.
i. Remove tourniquet.
j. Attach needleless connector. Flush using 10 mL normal saline syringe to
ensure patency.
k. No need to add extension as it comes already attached. Second port may
also be used. Clamp when not in use.
C. Catheter Securement and Dressing
1. Apply StatLock
®
anchor tape as follows for Pediatric populations where the PIV is
to remain in place for at least 24 hours:
a. Apply skin prep to targeted securement site.

Page 6 of 12

i. Do not use skin prep on pre-term infants. Use soap and water to
cleanse and degrease skin, then wipe the area with sterile normal
saline and allow to dry.
ii. For term infants, use an alcohol prep pad to cleanse and degrease
skin, then apply provided skin prep.
b. For BD Insyte
TM
Autoguard
TM
IV Catheter:
i. Press the StatLock
®
over the catheter hub to capture the push tab.
ii. Peel StatLock
®
paper backing one (1) side at a time and gently
press into place.
c. For BD Saf-T-Intima
TM
IV Catheter:
i. Remove transparent adhesive shield from wing securement side of
StatLock
®
pad.
ii. Lift the wings of the Saf-T-Intima
TM
Catheter and carefully
position the StatLock
®
pad at targeted securement site and firmly
place wings over designated adhesive area of pad.
iii. Peel StatLock
®
paper backing one (1) side at a time and gently
press into place.
d. If using securement device other than StatLock
®
, apply according to
manufacturer’s instructions.
2. Apply transparent dressing.
3. In inpatient adult settings where the IV catheter must be in place for more than 24
hours, the Tegaderm
TM
Advanced Securement Dressing should be used.
4. Write time and date on dressing.
5. Make a loose loop of IV tubing and secure with tape.
6. DO NOT use Biopatch
®
on PIV catheters. Direct visualization of the insertion site
is preferred, especially if catheter will remain in place longer than 72 hours; patient
is insensate or has decreased sensation at the insertion site; patient is obtunded; or
patient is elderly, pediatric or neutropenic. If the site is not visible, remove
covering and inspect the site at least once each shift and as necessary.
7. Circumferential taping is not to be used.
8. Coban is not to be used to secure catheter extension or tubing proximal to the
insertion site with exceptions for use in the OR as utilized by Anesthesia
personnel. Coban is to be removed prior to transfer of patient from PACU or at
bedside during handoff. Document removal in patient’s clinical record.
D. Documentation
1. Document the following in the patient’s clinical record: date, time, gauge, catheter
type, length, reason for placement, skin prep, site, number of attempts, analgesic
agent used, and if visualization devices were used.
2. Document rationale for deferred site changes and provider notification in the
patient’s clinical record.

VI. PROCEDURE – INITIATE INFUSION

A. Continuous Infusions
1. Connect administration tubing assembly to catheter/extension and open the clamp.
Program continuous infusion as ordered and initiate infusion. Check drip chamber
on infusion set to ensure solution is dripping. Palpate skin surrounding PIV site to
verify that solution is dripping into the vein and not subcutaneously.

Page 7 of 12

2. RN is responsible for programming, regulating and maintaining the rate of flow as
ordered.
B. Intermittent or Secondary Infusions
1. Administration of medication from a minibag
a. Attach minibag to secondary medication tubing. Reconstituted medication
may be provided in the minibag; if not, minibag may need to be backfilled
from primary fluid solution for reconstitution.
i. For minibag administration:
 Attach minibag to secondary tubing.
 Clear air from tubing.
 Cleanse Y-connection port with alcohol for 15 seconds, let dry
for 15 seconds and attach tubing securely.
 Open clamp on IV tubing and backfill as needed.
b. Before accessing the needleless connector, scrub the diaphragm end and
sides including luer threads for 15 seconds with a 70% isopropyl alcohol
prep pad and allow to dry 15 seconds. Maintain control of the needleless
connector during dry time (do not allow to rest on any surface after
disinfecting).
c. If PIV is capped, aspirate PIV for a positive blood return to confirm
patency. Inject normal saline flush as required. Observe site for swelling
or indications of infiltration such as burning or stinging.
d. Connect tubing to PIV, open clamp on IV tubing and secondary set and
infuse medication/solution at the prescribed rate. If the patient experiences
any discomfort during the administration, re-evaluate the PIV site for
possible infiltration.
e. Flush remaining medication in the drip chamber and tubing with 25-50
mL of the primary IV solution to insure administration of entire dose.
When changing minibags, backfill with approximately 10 mL and discard.
Attach new bag and backfill for administration. When medication infusion
is completed, leave empty minibag attached and hanging.
f. To maintain patency of the peripherally inserted venous catheter, inject 2-
5 mL normal saline, clamp extension set. Flush according to UWHC
Flushing Guidelines.
C. Administration of medication from syringe Pump Infusion:
1. Manual Priming Syringe Administration Set
a. It is important to prime set prior to attaching to patient and to clamp set
preventing uncontrolled flow.
b. Determine if a bifuse add-on is needed.
c. For initial priming, attach Microclave® to syringe pump tubing.
d. Manually prime the tubing by pushing the plunger with syringe tip up.
2. Loading Syringe
a. Clamp off fluid flow to patient to prevent accidental bolus before loading
or unloading syringe.
b. Insert syringe barrel flange between Barrel Flange Grippers (gray in
color).
c. When the Drive Head is lowered, hold the installed syringe plunger to
prevent an accidental push on the plunger.
3. Preparing Infusion – Selecting Syringe Type & Size
a. It is important to identify the Syringe manufacture and syringe size when

Page 8 of 12

loading syringe.
4. Programming Infusion
a. Select the medication from the Alaris Drug Library when programming
the infusion.
b. If drug not available in library, choose basic infusion.
c. The pump automatically recognizes the volume in the syringe and pre-
populates this as volume to be infused (VTBI).
d. Unclamp the tubing set before pressing start. The time to occlusion alarm
can be much slower (hours) with the syringe pump compared to the
regular large volume pump.
5. All Mode
a. The syringe pump “plans” to give all medication in the syringe. If you do
not want to give all medication to the patient, enter a new VTBI.
6. Near End of Infusion and End of Infusion
a. The syringe pump does not issue an alert to know that the infusion will
soon be complete.
b. There is no TKO rate for syringe infusions. Once the VTBI has been
infused, there is no fluid moving to keep the patient’s access device patent.
7. Syringe Empty Alarm
a. The syringe pump issues an Empty Syringe Alarm when the VTBI has
been delivered.
b. This alarm tone can be silenced and will re-sound at 2 minute intervals
until the empty syringe is changed or the Syringe Module is shut down.
8. Change Empty Syringe or Flush with Normal Saline Syringe
a. Flush remaining medication using a 10 mL saline flush syringe.
b. Press silence and pause. Install 10 mL saline flush syringe. Answer
syringe information prompts.
c. Use Restore to start the next “same” infusion or to flush at the same rate.
9. Check Syringe Alarm:
a. Follow screen prompts for misloaded Syringe Barrel Clamp and/or
Plunger Grippers.
10. Occluded – Patient Side Alarm:
a. Occlusion alarms are issued when the Syringe Module has detected
increased back pressure. Check the tubing clamp to ensure it is open and
must also check to ensure the tubing is not kinked or twisted to impair
flow.
B. IV Push Administration:
1. Before accessing any needleless connector, scrub the diaphragm end and sides
including luer threads for 15 seconds with a 70% isopropyl alcohol prep pad and
allow to dry 15 seconds. Maintain control of the needleless connector during dry
time (do not allow to rest on any surface after disinfecting).
a. IV Push via Alaris Tubing: Use the most distal needleless connector port.
Do not use a needle in IV pump tubing connectors as it will rupture the
valve.
2. Aspirate PIV for a positive blood return to confirm patency. Inject normal saline
flush as required. Observe site for swelling or indications of infiltration such as
burning or stinging.
3. Attach medication syringe and inject medication at the designated rate from the
medication syringe. Complaints of pain or burning during injection may be a sign

Page 9 of 12

of infiltration and warrant further investigation. Be alert to the signs of phlebitis
and infiltration.
4. Remove medication syringe and flush catheter according to UWHC Flushing
Guidelines.

VII. PIV ASSESSMENT

A. Patient Assessment
1. If symptoms of circulatory overload appear, slow the rate of flow to just keep PIV
open and notify the physician.
2. In pediatrics, if symptoms of circulatory overload appear – notify physician for
collaborative assessment and orders.
3. If the patient appears to be experiencing shaking chills or allergic or toxic reaction,
change the solution and set and notify physician; preserve sterility of set and
solution and save the solution and set for possible culture or other analysis. Notify
Infection Control at the same time, who will investigate if indicated.
4. In adults, PIV catheter sites are to be inspected at least once every eight (8) hours.
In pediatrics, PIV catheter sites are to be assessed and documented on hourly.
Assess PIV site for signs of infection (i.e., warmth, erythema, drainage), palpate
for pain or tenderness and ensure dressing is dry and intact. Pain on palpation is
one of the most important early indicators of phlebitis. Pain usually occurs before
local redness at site is apparent. Change PIV catheter to a new location. New onset
fever with no obvious source is another reason to remove PIV and establish access
in a new location.

VIII. PIV MAINTENANCE AND DISCONTINUATION

A. PIV Site Care
1. Routine periodic site care is not required for peripheral venous catheters unless the
dressing has become soiled, wet, loose or left in place for longer than 72 hours.
2. Catheter Assessment
a. Check frequently for infiltration, inflammation, reactions, the security of
dressings, and for the proper rate of flow.
b. Palpate the site routinely through the dressing for evidence of heat or
tenderness.
c. Visually inspect for erythema, swelling, or drainage around the dressing.
B. Catheter Change
1. Change PIV catheter for routine peripheral infusions in adults at least every 72
hours, sooner if complications occur. Indications for removal include pain,
infiltration, phlebitis, purulent thrombophlebitis, leakage or stoppage of flow,
unexplained fever, signs of infection and/or high-grade bacteremia from another
body site.
2. Depending on the patient’s clinical need, it may be appropriate to leave the
catheter in for greater than 72 hours:
a. For Adults:
i. For adults with limited sites for venous access and there is no
evidence of complication, it is acceptable to leave the catheter in
place for longer periods on a day by day basis provided that the

Page 10 of 12

insertion site is closely monitored for signs of phlebitis or other
complications, and the site care is done every three (3) days.
 Documentation and Communication: When changing PIV
catheters is not possible, provider should be aware of
limited venous access concerns and RN should document in
the patient’s clinical record if device is to be left in place
more than 72 hours via progress note. The note should
address the extenuating circumstances. The PIV site should
be assessed frequently for catheter-related complications.
ii. Pediatrics: For pediatric patients, peripheral venous catheters may
be left in place until the intravenous therapy is completed unless a
complication occurs. However, the insertion site must be closely
monitored and site care must be done every three (3) days. If risk
of dislodgement is great and venous access is limited, dressing
changes may be extended to every seven (7) days.
C. Dressing Change
1. Remove tape, StatLock
®
or other manufacturer’s device, and dressing over the PIV
site without disturbing the catheter/needle if soiled or wet. Inspect site.
2. Cleanse PIV puncture site and hub of the device with ChloraPrep
®
. Let dry. Apply
new transparent dressing and StatLock
®
or other manufacturer’s device.
D. Tubing Change
1. Change IV administration set, extension set, needleless connector, piggy-back
tubing and anesthesia extender for routine infusions every 72 hours. Exceptions:
a. Blood Tubing – The administration set should be changed every four (4)
hours and not to exceed a maximum of eight (8) hours. When hanging a
subsequent product for infusion on the same tubing, one should consider
whether the administration will exceed the four (4) hour limit and utilize a
new administration set. More frequent changes may be necessary as debris
collects on standard in-line filter and impedes flow. Refer to UW Health
Clinical Policy 2.2.6, Blood and Blood Component Transfusion
(Requiring Pre-Transfusion Testing).
i. Lipids – Replace tubing and filter used to administer lipid
emulsions alone (total lipids) every 12-24 hours.
b. Propofol: Replace tubing used to administer propofol infusions every 6-12
hours, when the vial is changed.
c. Discard all parenteral fluid not used within 72 hours after initiation.
d. Clamp off old tubing.
e. Use luer lock connections to prevent disconnections.
i. Grasp the hub of the device securely (may use sterile forceps) and
with the other hand twist connector of the old tubing to loosen it
from the hub.
ii. Attach new tubing to the hub of the device or needleless
connector valve and twist connector to ensure a secure connection.
f. Adjust IV flow rate to ensure patency during the remainder of the
procedure.
E. Discontinuing PIV Catheter
1. These instructions apply to the discontinuance of a PIV device that is four (4)
inches or less in length.

Page 11 of 12

2. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene.
3. Put on exam gloves. Remove tape and transparent dressing, applying alcohol or
adhesive remover to minimize trauma to the skin. Remove StatLock
®
device, using
alcohol to loosen the adhesive and minimize skin trauma (adhesive remover is
NOT indicated for StatLock
®
removal).
4. Remove PIV catheter, immediately applying pressure to site with a dry sterile
dressing to the catheter insertion site. For those on anticoagulant therapy and/or
with low platelet counts, pressure will need to be applied for a longer period of
time (2-5 minutes). Apply a Band-Aid or tape over the 2x2 gauze. Check to make
sure bleeding has stopped after dressing is applied.
5. Inspect the catheter tip and confirm the presence of the intact catheter/hub (and
extension if present). If there is concern that any portion of the catheter has
fractured or broken off during removal immediately apply pressure proximal to the
catheter dwell site to prevent fragment migration within the vein and contact the
patient’s provider.
F. Documentation
1. Site care and assessment
2. Amount of fluid infused at appropriate intervals and when bag/container is
changed.
3. Patient's response to therapy.
4. Tubing change
5. Discontinuation of PIV

IX. UW HEALTH CROSS REFERENCES

A. AFCH/Pediatric Resources (on U-Connect)
B. UW Health Clinical Policy 2.2.6, Blood and Blood Component Transfusion (Requiring
Pre-Transfusion Testing)
C. UW Health Clinical Policy 4.1.13, Hand Hygiene
D. Nursing and Patient Care Policy 1.24 AP, Alaris System (Adult & Pediatric)
E. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)
F. Nursing Practice Guidelines: Infection Prevention for Intravascular Catheters (on U-
Connect)
G. Pediatric Vascular Access Algorithm (see Related Resources)
H. Starting an IV Doesn’t Have to Hurt (see Related Resources)
I. UW Health Guidelines for Flushing/Locking of Venous Access Devices in Adult &
Pediatric Patients

X. REFERENCES

A. Brown, D. (2004). Local anesthesia for vein cannulation; a comparison of two solutions.
Journal of Infusion Nursing, 27(2).
B. Fein, J., & et al. (1998). Saline with benzyl alcohol as intradermal anesthesia for
intravenous line placement in children. Pediatric Emergency Care, 14(2), 119-122.
C. Hospital Infection Control Practices Advisory Committee (HICPAC) (2011). Guidelines
for the Prevention of Intravascular Catheter-Related Infections.

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D. Josephson, D. L. (2003). Intravenous infusion therapy for nurses: Principles and
practice. Retrieved from Cengage Learning, 468-474.
E. Lamagna, P., & MacPhee, M. (2004). Troubleshooting pediatric peripheral IVs: Phlebitis
and infiltration. Nursing Spectrum. Available from Internet:
http://news.nurse.com/apps/pbcs.dll/article?AID=2004407010305
F. Marschall, J., Mermel, L. A., Classen, D., Arias, K. M., Podgorny, K., Anderson, D. J., &
Yokoe, D. S. (2008). Strategies to Prevent Central Line–Associated Bloodstream
Infections in Acute Care Hospitals. Infection Control and Hospital Epidemiology,
29(Supp 1), S22-S30.

VII. REVIEWED BY

Clinical Infection Control Practitioner, Infection Control
Clinical Nurse Manager, Venous Access Team
Clinical Nurse Specialist, Infusion
Clinical Nurse Specialist, Universal Care Unit & Float Team
Nursing Education Specialist
Nursing Patient Care Policy and Procedure Committee, December 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive