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****************************************************** Articles:
I.V. Therapy and Liability Issues, Deborah Buchanan, RN, MS, CLNC, Medical/Legal Consultants of Colorado:"There are many potential complications associated with the use of intravenous therapy. These include damage to the nerves, either by the actual needle stick or by compression caused by infiltrated I.V. fluid, phlebitis, nosocomial infection, allergic reaction to the indwelling cannula, air embolisms, speed shock, a severed catheter, and circulatory overload. While this may seem like a daunting list, most law suites arise from just two of these complications: infiltration of I.V. fluids and phlebitis. These are two complications that most juries feel are preventable." ******************************************
The Practice of IV Therapy by Licensed Practical Nurses in Acute Care Settings, Current Issues in Nursing:"In response to numerous inquiries concerning the role of the licensed practical nurse (LPN) in the administration of intravenous therapy in acute care settings, the New York State Board for Nursing provides the following guidance document.
The role of the LPN in providing intravenous therapy is determined by a number of factors including the complexity of the procedure, the degree of direction, the setting, as well as the skill and competence of the licensee. A Registered Professional Nurse (RN) may delegate select activities associated with the administration of intravenous therapy to an appropriately competent LPN. The delegation of these activities is based on the RN's professional judgement, the competence of the LPN, policy and procedures of the institution and standards of nursing practice." ****************************************************** ****************************************************** Intravenous Medications: A Handbook for Nurses and Allied Health Professionals, by Betty L. Gahart, Adrienne R. Nazareno:"This best-selling handbook has been revised with hundreds of new drug facts and approximately 10 to 15 new monographs for FDA-approved IV drugs. More than 350 drug monographs are presented in a clinically useful format notable for its consistency, comprehensiveness, and accuracy. Revised annually, INTRAVENOUS MEDICATIONS gives health care personnel quick access to accurate IV drug information in an easy-to-use format." ****************************************** I.V. Q & A: Drawing Blood Samples from Lines:"Standard of Practice #33 addresses blood drawing from pre-existing cannulae and IV administration lines/sets. As you’ll see, indwelling devices aren’t recommended for routine blood draws. But obtaining blood while inserting the cannula is perfectly permissible. The device is “virginal,” if you will, in that no medications or infusates have been infused via the device." ****************************************** Choosing a Site:"If you have a patient who does not have any accessible sites in the upper extremities, what are the pros and/or cons to insertion of a peripheral catheter in the lower extremities?" ****************************************** Priming/Flushing the Secondary Set:"we are reviewing the implementation of a policy using back priming/flushing the secondary set with the primary fluid. Some clinicians are questioning the capability of drugs, primarily antibiotics, due to the possibility of drug leaching into IV tubing and subsequent untoward reactions." ****************************************** Site Checks:"Observation of IV cannulation sites certainly is dependent on many factors including patient population (pediatrics, geriatrics, critical care), infusates being administered, electronic-versus gravity-assisted infusions, competency levels of professional staff, etc." ****************************************** I.V. Access for Obese Patients:"Short of blind sticks, what’s the best method of obtaining large-bore I.V. access in mildly and morbidly obese patients?" ******************************************
Guideline For Prevention
Of Intravascular Device-Related Infections: National Center for Infectious
Diseases Centers for Disease Control and Prevention
Hospital Infections
Program (HIP): Dedicated to assisting the Public Health Service, state
and local health departments, hospitals, and professional organizations
worldwide in the prevention and control of nosocomial infections.
Mantoux Tuberculin
Skin Test (Tuberculosis Screening Test): Adapted from the CDC. Preservative- Free Normal Saline:"The current practice of oncology nurses is the use of preservative-free normal saline for flushing VADs. My previous experience in this type of setting has involved the use of bacteriostatic normal saline for flushing (except, of course, for patients with sensitivity to benzyl alcohol). In an outpatient setting, the volume of patients treated dictated preparation of normal saline flushes well in advance. Preparation and use of preservative-free normal saline over several days raises concern about sterility." ******************************************
Intravenous therapy, Wikipedia.org:"Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means "within a vein", but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called specialty pharmaceuticals.
Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections, can only be given intravenously." ******************************************
Home I-V instructions, Jeffrey J. Wine:"Check with your doctor and Home Care Professional for changes to these instructions. These are based on experience with home IV done in 1996. Send email if you have additional questions. ****************************************** Intravenous Therapy Nursing Consultants:
Lucille "Lou" Addington, RN, CLNC, Florida:"We do medical-legal consulting for attorneys, insurance companies and HMO's, and private individuals. Presuit investigations and affidavits. Expert witness location. Special interest in vaccine damage cases and long term care/elder care issues. My associate and I bring a combined 42 years of professional nursing practice to our cases."
Randy Ross R.N., B.S.N IV's Etc... LLC. ******************************************************
Perivascular Nurse Consultants, Inc.:"Perivascular Nurse Consultants, Inc. is an independent educational training and legal consultation firm. PNC is nationally recognized for excellence as a provider of infusion therapy education programs. Faculty includes nurses with over ten years hands-on IV therapy experience in hospitals, homecare, long term care and out-patient settings. To their credit they have over 100 printed journal articles. The main goal of PNC is to educate other healthcare providers, attorneys, and the community in the proper initiation, administration and maintenance of intravenous therapy and vascular access devices." ******************************************************
PICC Excellence Inc.:"PICC Excellence provides professional instruction in all aspects of Peripherally Inserted Central Catheters (PICC), midclavicular and midline catheters. Since 1994, PICC Excellence has trained over 3000 IV and vascular access professionals throughout the U.S. and Internationally. PICC Excellence has the experience and knowledge to design custom training programs to meet your IV and vascular access educational needs." http://www.PICCExcellence.com ******************************************
Intravenous Nurses Society:
League of Intravenous Therapy Education:
OSHA: Bloodborne
Pathogens Final Standard: Summary of Key Provisions
Lidocaine and Prilocaine Cream (EMLA) for Topical Anesthesia in Children: ****************************************************** Position Statements:
Post-Exposure Programs in the Event of Occupational Exposure to HIV/HBV: ******************************************************
Total Parenteral Nutrition, TPN:
http://www.intravenousnursing.com
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