Maintenance of the IV

Maintaining the IV catheter
1. Check for continued patency
2. Flush the IV catheter at every assessment, per policy or when giving IV medications
  1. Includes piggybacks or intermittent IV meds
3. Assess for blood return
4. KVO (keep vein open)
  1. Some discrepancy among literature at the rate necessary
  2. Use judiciously
  3. Ensure an order is in place
  4. Follow hospital or facility policy
Insertion site and vein
1. Check with each flush and assessment for any phlebitis, redness or streaking
2. If patient complains of pain, check the fluid type (some fluids can be irritating)
  1. Examine for extravasation or edema locally
  2. Discontinue fluid therapy and utilize other veins
3. Assess for leaking
Dressing
1. Maintain a clean, dry and intact IV dressing
2. Change the dressings per policy
3. Reinforce as necessary
4. When changing the dressing, always secure the IV first to maintain integrity

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Transcript

Okay guys, in this lesson we’re going to talk about maintaining the IV. When I talk about maintaining the IV, it’s based on three different factors. Number one, we’re looking at the IV itself. We want to make sure that the thing’s working. The second thing we’re going to look at is the actual IV site. We’re looking at what kind of integrity’s there, and the last thing that we’re going to look at is the actual dressing in the securing of that IV. Anytime you’re assessing the actual catheter itself, you want to do a couple of things. The first thing you want to do is look at Peyton Z. When I say Peyton, see I’m talking about the openness or the ability for that catheter to stay open. There’s a couple of ways that you address this. The first one is making sure that you’re flushing it per policy or on your assessments.

It’s not uncommon to have IV, uh, flushes done at every assessment, which was every four hours when I was working in SICU. Now you can use that to your advantage to make sure, Hey, I’ve got frequent assessments on the actual integrity of the IV. The other thing you can do is also apply a little bit of negative pressure. See if you get blood return. That’s also a great indication that the IVs not having any complications right at the end, that lumen of that IV catheter. One other thing that you guys can do that not uncommon is KVO, which means keep vein open. What Caveo is is it’s a trickle rate, meaning that your patient’s hooked up to an IV catheter and an IV fluid set and they’re getting like five ml an hour. There is some discrepancy in what’s actually effective in terms of keeping the vein open, but an a not uncommon rate is somewhere between five and 10.

However, if you do this and it is available for you to practice in your area, make sure that you have two things done. Number one is that you make sure that it’s safe for your patient. The last thing you want to do is have a patient that you’re taking care of that has congestive heart failure and you’re continuing to load them up with fluids for the sake of keeping their eyes open. That’s not good practice and it’s not good for your patient. The second thing you want to do is make sure that you have an order for it. You need to make sure that you’re following those proper protocols and that you’re following facility policy. Now let’s talk about the actual insertion site. Remember, you’ve got literally a silicone tube inside your patient’s vein, so you need to be monitoring them. That means that you need to be doing frequent assessments and that you’re checking out things like phlebitis or extra visitation or any sort of other complications that your patient could be having.

If your patient complains of discomfort or pain while getting an infusion, always stop the infusion and then come back and see what’s going on with the actual site. If you are doing good practice, you should always be able to get one step ahead of the game on this. The last thing you want to check for is leaking. Anytime leaking occurs, it doesn’t mean that the catheter is not Payton or it’s not working. Sometimes it just needs to be reinforced. The problem is over time that there’s a little bit of space that’s created from where that IV is and it just leaks out. As long as you try to keep that, that IV clean, dry and intact. Keep it, patent keep it open and it’s not causing the patient any problems. A leaking IV is totally okay. Just make sure that it’s not doing any one of those other complications.

The last thing we want to talk about is dressing. You always want to make sure that your dressing is clean, dry and intact and also make sure as time, date and initial that way we know when it was last change and you could also do other things that are important to the dressing, like making sure you’re following a policy when it comes to making sure that those things are changed. If it’s going on a long time that that hasn’t been changed. You actually lead your patients to have things like infections and other complications. So always make sure you’re following facility policy when you’re doing those dressing changes if you need to. You can always reinforce it, but that’s going to help maintain the integrity of that IV. I hope that these tips have been helpful. Now go out and be your best selves today and as always, happy nursing.

Maintenance of the IV

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