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Initiating a Peripheral Intravenous (PIV) Line and PIV Therapy (102.051)

Initiating a Peripheral Intravenous (PIV) Line and PIV Therapy (102.051) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, IV and Fluids

102.051

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: INITIATING A PERIPHERAL INTRAVENOUS (PIV) LINE AND PIV THERAPY

Effective Date: September 2012 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed


PURPOSE: To provide guidelines for the safe insertion of a peripheral intravenous (PIV) access device and initiation of
PIV therapy at UWMF and DFM Clinics.

POLICY: The (R.N.) clinical staff will utilize the following guidelines to insert the PIV, select the proper solution, and
monitor the patient status.

The L.P.N., only after being certified in PIV skills, under the direction of the R.N. or provider may insert a PIV and select
the appropriate solution. The L.P.N., under the direction of the R.N. or provider may maintain the PIV site, per the
following procedure, and monitor the patient status. However, the responsibility for any part of this procedure remains
with the supervising R.N. or provider.

DEFINITION: Starting PIV therapy may include but is not limited to the following activities: insertion of the PIV access
device, hanging the appropriate solution, maintaining the PIV site and monitoring the patient’s status.

SUPPLIES: Provider’s order,
PIV access device size 18, 20, 22 or 24 gauge
PIV start kit OR tape, alcohol swab, transparent adhesive dressing
Prescribed solution, PIV tubing, IV pole, arm board (if necessary)

PROCEDURE:

1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather supplies.

3. Introduce yourself and provide privacy.

4. Identify patient including full name and date of birth and verify allergies.

5. Explain procedure to patient.

6. Prepare IV solution and tubing: (Review policy on IV SOLUTIONS)
a. Maintain aseptic technique when opening sterile packages and IV solution.
b. Remove plastic cap from IV solution’s entry site on bag.
c. Clamp tubing, uncap spike, and insert into entry site on bag.
d. Hang IV bag on IV pole or infusion pump (if applicable)
e. Squeeze drip chamber and allow it to fill at least half way.
f. Release clamp and allow fluid to move through tubing.
g. Allow fluid to flow until all air bubbles have disappeared.
h. Close clamp and recap end of tubing, maintaining sterility of setup.

7. Place patient in a comfortable position.



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8. Place protective towel or pad under patient's arm.

9. Select appropriate site and palpate accessible veins.

10. If site is hairy clip/shave a 2-inch area around intended entry site.

11. Apply tourniquet 5-6 inches above venipuncture site to obstruct venous blood flow and distend vein. Direct tourniquet
ends away from entry site.

12. If vein is not prominent ask patient to open and close fist several times.

13. Observe and palpate for a suitable vein.

14. Try the following techniques if vein cannot be felt:
a. Release tourniquet and have patient lower arm below level of heart.
b. Reapply tourniquet and gently tap over intended vein to help distend it.
c. Remove tourniquet, place warm, moist compresses over vein for 5 minutes.

15. Put on clean gloves.

16. Using a friction scrub (press down & scrub in all directions), cleanse entry site and
surrounding area within several inches from site with an antiseptic solution - alcohol
swab (followed by antimicrobial solution - povidone iodine, if indicated or as needed).

17. Use nondominant hand, placed about 1-2 inches below entry site, to hold skin taut against vein. Avoid touching
prepared site.

18. Enter skin gently with catheter held by the hub in the dominant hand, bevel side up, at a 10-30° angle. Catheter may
be inserted from either directly over vein or from side of vein.


19. While following the course of the vein, advance needle or catheter into vein. A sensation of "give" can be felt when
needle enters vein.

20. When blood returns through lumen of needle or chamber of catheter (flashback), advance device 1/8 to 1/4 inch
further into vein. Catheter needs to be advanced until hub is at venipuncture site but exact technique depends on type
of device used.

21. Quickly remove protective cap from PIV tubing and attach tubing to catheter. Stabilize catheter with nondominant
hand. Release tourniquet.

22. Start solution flow promptly by releasing clamp on tubing. Examine tissue around entry site for signs of infiltration.

NOTE: If signs of infiltration are present, immediately stop the flow of solution. Use gauze pad to cover site and
remove PIV catheter. Apply pressure at site until hemostasis is achieved. Apply tape over gauze pad or apply bandage
over insertion site.


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23. If PIV is patent and solution is infusing well, secure catheter with Tegaderm® or other bio-occlusive dressing.

24. Loop tubing near entry site and anchor to dressing.

25. Mark date, time, and type and size of catheter used for insertion on the tape.

26. Anchor tubing to arm.

27. Adjust rate of solution flow according to provider order.

28. Remove all equipment and dispose in proper manner.

29. Remove gloves and wash hands.

30. Monitor patient first 5 to 10 minutes of the infusion for any sign of complication.

31. Instruct patient to inform you of any pain, redness, or swelling at or near PIV insertion site.

32. Evaluate patient response to PIV therapy

33. Documentation Progress Notes section of patient record in HealthLink
a. Patient education
b. Procedure performed – utilizing appropriate smartphrases
 .npivst – insertion of PIV access device
 .npivinfusion – information related to solution administered
 .npivat – if insertion of PIV access device in unsuccessful & requires more than one attempt
c. How patient tolerated procedure (if not included in smartphrases)
d. Patient response to therapy


WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
Rebecca Harrison, RN, TL, East Towne Urgent Care

REFERENCES:
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5
th
ed.). Ambler, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5
th
ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7
th
ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO:
Mosby Elsevier.

AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine

_______________________________________________________________________________
Medical Director, UWMF

________________________________________________________________________________
Vice Chair, Department of Family Medicine