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Nursing

Paediatric IV Therapy

IV Therapy

Intravenous therapy is an important part of the treatment of many hospitalized patients. IV solutions are medications. Administration of medications is part of the controlled acts authorized to nursing. It is the nurse’s responsibility to ensure that the patient receives the ordered solution and additives at the ordered rate. The extravasation of any IV fluid can cause serious permanent harm. Hourly checks are necessary in order to identify an extravasation early.

IV solutions often have similar packaging, therefore, great care is required in selecting the right intravenous solution. Particular care is required if the patient has more than one IV line or pump to ensure that lines are not mixed up. When an IV bag is changed or if a medications are being added to one of the lines, the line must be tracked right back to the solution container to verify that the additive is being added to the correct line. 

Indications for IV Therapy

  • Supply parenteral fluids to:
    • maintain daily requirements
    • restore losses
    • replace ongoing losses
    • maintain electrolyte balances
    • correct fluid & electrolyte disturbances
  • Administer blood and its components
  • Administer parenteral medication (e.g. antibiotics, chemotherapy, analgesics)
  • Administer TPN (Total Parenteral Nutrition)
  • Provide intravenous access in case of an emergency
  • Provide access for diagnostic purposes (e.g. dye injection prior to a procedure)

IV Maintenance

  • IV maintenance is the nurse’s ongoing responsibility. 
  • IV solution bags and syringes are to be replaced at least every 24 hours
  • IV tubing is changed at a minimum of every 96 hours for continuous infusions (Intermittent and lipid containing IV tubing is changed very 24 hours)
  • Tubing, bags and syringes are labelled with the date and time of change and documented in EPIC
  • IV dressing changes are done as necessary based on assessment. DO NOT REINFORCE wet or soiled tapes - change them and ensure that tapes and IV board are clean
  • Luer-activated devices (smart-sites) are cleaned  before accessing with antiseptic swab scrub for 15-30 seconds and allowed to dry for 15-30 seconds
  • At the beginning and end of each shift, and every time an IV bag is changed, the solution and rate of infusion are checked against the current medical orders
  • All IV therapy must be checked for rate, solution and additives by the nurse coming on duty and the nurse going off duty. Students are also welcome to participate as a third check.

IV Site Assessment & Care

 

 

 

 

 

  • Volume infused and solutions infused are documented hourly
  • Assess IV site hourly (at a minimum), and document.
  • Under good light, visualize the insertion site, as well as above and below
  • Palpate and inspect site for puffiness, redness, blanching, skin temperature (very warm or very cool), wetness, streaking, and/or cording
  • Compare limbs - Is there generalized edema or is only the limb with the IV edematous?
  • Assess child's comfort level - Is the IV site tender to touch or painful ?
  • Observe IV dressing to ensure that it is clean and intact
  • Set the appropriate pressure limits on the pump. Never rely on your IV pump as a means of confirming patency - the pump may continue to infuse the IV solution into the surrounding tissues of an infiltrated IV
  • When disconnecting an IV, ensure that the end of the line is capped in an aseptic manner. If becomes contaminated, discard the line.
  • When the IV team is called in to assess an IV, saline lock the PIV. Do not put on hold or turn off the IV infusion pump while waiting for the team to arrive. This may result in line occlusion.

Quick reference on PIV site assessment

Potential IV Complications

Severe IV complications are largely preventable. It is important to identify and treat complications, and the goal is to prevent them by:

  • closely monitoring
  • maintaining asepsis
  • thorough assessment
  • troubleshooting IV sites

Complications

  • Infiltration/ Extravasation: Dislodgment of cannula from the vein into the surrounding tissue
  • Site Infection: Infection at the IV insertion site
  • Haematoma: Localized swelling filled with blood resulting from a break in a blood vessel
  • Phlebitis: Inflammation of the vein

Tip Sheets

What do I do if  .....

Upon begging your placement, you are required to review the following SickKids policies:

  • Intravenous (IV) Therapy Administration and Guidelines
  • Central Vascular Access Devices (CVAD)