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Line Maintenance and Monitoring of Peripheral Intravenous Lines (102.053)

Line Maintenance and Monitoring of Peripheral Intravenous Lines (102.053) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, IV and Fluids

102.053

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: LINE MAINTENANCE AND MONITORING OF PERIPHERAL INTRAVENOUS LINES

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

Reviewed


PURPOSE: To provide guidelines for line maintenance (solution & tubing changes) and monitoring of
patients with peripheral intravenous (PIV) sites and PIV infusions at UWMF and DFM Clinics.

POLICY: The R.N. staff will utilize the following guidelines to properly monitor the PIV site, change IV
solutions and tubing, and monitor the status of patients receiving a PIV infusion.

The L.P.N. under the direction of the R.N. or provider will utilize the following guidelines to properly monitor
the PIV site and monitor the status of patients receiving a PIV infusion, after being certified in IV skills.
However, the responsibility for the procedure remains with the supervising R.N. or provider.

DEFINITION:
IV Tubing Changes – removing existing PIV tubing and replacing with new set of tubing. This may be
necessary if accidental puncture of the existing tubing has occurred, the solution attached to the tubing
develops particulate matter or other signs of contamination, or the patient experiences an adverse reaction
during infusion therapy. Tubing changes also should take place every 72 hours for those patients with
continuous infusion therapy.

PROCEDURE:
Monitoring (Patient, PIV site, Infusion)

SUPPLIES: Provider’s order, patient record

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

2. Wash hands.

3. Identify patient, including patient’s full name and date of birth & verify allergies.

4. Patient education:
a) Reason for IV and need for monitoring
b) When to call for assistance:
Any discomfort at IV site
Solution container is nearly empty or flow has changed in any way
Signs of allergic reaction (hives, itching, shortness of breath)

5. Assist patient to sit or lie in a comfortable position while the IV is being infused.

6. Monitor IV solution infusion as needed. (Frequency of checks will vary depending on solution, age and
condition of patient).
NOTE: More frequent checks may be necessary if a medication is infusing.


7. Observation/Monitoring
a) IV equipment/infusion
check solution bag for signs of discoloration, particulate matter, etc.
verify that clamp is in open position
check tubing for anything that might interfere with flow (kinks, twists, etc)
verify that all connections as secure and without leaks

NOTE: If solution becomes contaminated with particulate matter during infusion:
o Stop infusion and clamp IV line
o Change IV solution immediately and flush with saline
o Alert pharmacy and monitor patient
o Complete PSN

b) PIV site inspection
Swelling or pallor – may indicate infiltration
Pain, redness, warmth/heat – may indicate phlebitis
NOTE: If PIV shows signs of phlebitis or becomes infiltrated, stop infusion and discontinue
IV. Consult with provider for possible order to restart IV infusion at new site.

c) Patient status – observe for
Response to therapy
Signs of allergic reaction (rash, hives, itching, shortness of breath)
NOTE: If reaction occurs:
o Close IV line and immediately flush with saline
o Contact provider and call 911 (if reaction is anaphylaxis in nature)
o Complete PSN

8. Documentation (Progress Notes in HealthLink)
Smartphrase: .npivmonitor
Patient education provided

Changing PIV Solution

SUPPLIES: New IV solution container, Provider’s order

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

2. Gather supplies, checking the expiration date on the IV solution.

3. Identify patient including patient’s full name and date of birth. Explain reason for change in IV fluid(s) to
patient, i.e., new solution ordered, present bag is empty, etc.

4. Have patient sit or lie in a comfortable position while IV fluids are being changed.

5. Wash hands and put on disposable gloves.

6. Prepare IV solution, completing the “5 rights” of medication administration:
Right – drug, dose, time, route, patient

7. Remove outer wrap from IV container. (Bag may be wet from condensation).


8. Inspect bag carefully for tears, leaks, discoloration, cloudiness, or particulate matter. If ANY of these items
appear, discard solution, get new container. Remove covering from IV container’s access port, maintaining
sterility of port.

9. Check drip chamber and ensure that it is at least half full before proceeding.

10. Close clamp on tubing of empty or old bag or bottle.

11. Lift empty solution container off IV pole and invert it. Quickly remove spike from old IV solution container
being careful not to contaminate it.

12. Steady new solution container and insert spike into port, (1 to 2 inches) holding the neck of the port tightly
to prevent skipping and possible contamination.

13. Check for air in tubing.
NOTE: If bubbles form they can be removed by closing roller clamp, stretching
tubing downward and tapping tubing with finger (bubbles rise in fluid to drip
chamber).

14. Hang new IV solution container on pole and squeeze the drip chamber until
chamber is 1/2 filled with solution.
NOTE: If drip chamber is too full, pinch off tubing below drip chamber, invert
container, squeeze chamber, hang container and release tubing.

15. Reopen roller-clamp on tubing and adjust the IV flow.

16. Monitor patient first 5 to 10 minutes of the infusion for medication reaction. Such
as hives, shortness of breath, tachycardia.
NOTE: If reaction occurs:
Immediately flush with saline
Contact provider and call 911 (if reaction is anaphylaxis in nature)
Fill out PSN (patient safety net)

NOTE: If solution becomes contaminated with particulate matter during infusion:
Stop infusion and clamp IV line
Change IV solution immediately and flush with saline
Alert pharmacy and monitor patient
Fill out PSN

17. Discard used equipment in proper manner and wash hands.

18. Documentation (Progress Notes in HealthLink)
Smartphrase: .npivinfusion
Patient education
How patient tolerated procedure









PIV Tubing Changes

SUPPLIES: Primary PIV tubing set, IV solution

1. Wash hands and gather supplies.

2. Identify patient, including patient’s full name and date of birth. Explain reason or need for the change in
IV tubing.

3. Open IV administration set and close clamp on new tubing. Inspect tubing for tears, discoloration and
discard damaged equipment.

4. Remove outer wrapping from IV solution container.

5. Remove caps from both the end of IV solution container and spike of IV tubing. Maintain sterility of both
ends.

6. Using sterile technique, insert tubing spike into new IV container.

7. Hang IV container on pole and squeeze drip chamber to fill at least halfway.

8. Remove cap at end of tubing, release clamp, and allow fluid to move through tubing until all air bubbles
have disappeared.

9. Close clamp and recap end of tubing maintaining sterility of setup.

10. Loosen tape at IV insertion site.

11. Put on clean gloves and carefully remove dressing and tape.

12. Place sterile gauze square under hub of PIV catheter.

13. Place new IV tubing close to patient's IV site and slightly loosen protective cap.

14. Clamp old IV tubing.

15. Steady hub of PIV catheter with non-dominant hand.

16. Remove tubing with dominant hand using a twisting motion.

17. Set old tubing aside.

18. Maintaining sterility, remove cap from new IV tubing and insert sterile end of new tubing into hub of PIV
catheter.

19. Twist to secure it.

20. Remove soiled gloves, and dispose of gloves appropriately.

21. Open roller-clamp and regulate IV flow according to provider's order.


22. Reapply dressing at PIV site.

23. Discard used equipment in proper manner and wash hands.

24. Documentation (Progress Notes in HealthLink)
Reason for tubing change
Date, time, procedure performed
How patient tolerated procedure
Patient education

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:
Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Society.
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th 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