TPN tubing change frequency

PICC exchangeMessage to Nurses (Disclosure on this site)Product Change OverHistory & Physical prior to PICC placement?Using post mastectomy arm for PICC??Nitroglycerin and Insulin infusions"Chair" for PICC insertionVein/catheter ratio - Physician educationCVAD occlusionsPicc and Vas cathPerforming Chest X-rays for PICC placement in the Emergency DepartmentAfter PICC placement, process inquiryVasoNovaVasoNovaorientation of nurse to ultrasound picc line insertion with ecg tip confirmationOutpatient Dressing Changespicc line occludingPhlebotomydisinfecting central line capsPower Injectable MidLinesStop SignChlorhexidine PICC and CLABSIRheumatology patientsInfiltration scalePower PortsPower Wand Billing/ Coding?Identifing veins used for accessIdentifying veins used for venous accessIdentifying veins used for venous accesslab parameters for PICC line placement at bedsideECG use with good results with PICC tip in the azygous24 hour Dsg Chg Post PICC Placement due to sterile gauze at insertion siteInfusion pumps evalFactor VII and partial central line occlusionPICC nurse credentialingDiscontinuing quintin cathetersquestioning my judgement about PICC placementExtravasation of CT contrast treatmentRegitine shortagePICC insetion, measurement for obese pts.PICC tracking fields for data base.IV set changes for TNA (TPN) without Lipid Emulsionsport protector/ IPA devicePediatric PICC insertionsOver the wire catheter exchangeOver the wire catheter exchangeStaffing agency nurses for infusion clinics?PICC related thrombosisWe do almost all adult patientspost code situation-does PICC need to be exchanged?Teflon catheters3M Tegaderm 1683 IV DressingRepeat CXR after PICC retraction - what's your practice?Using Vacutaners with Picc lines for blood drawsTip locating systemsYour help is needed. Catheter exchange liability. hohn/ij cathetersNo blood return from one lumenBaxter Clearlink neutral valves for central lines and PICCsCLABSI BenchGone for 2 weeksFlushing Policy gadsSecuracathCharting line necessity in EMRIntrathecal dressing changesPICC line in 2 yearsantibiotic lock therapyMEDWATCH Zofran informationFor anyone having trouble accessing the forumChecking blood return during infusions of vesicant chemo via central linesHAPU's with PIV'sPediatric maximum sterile barrierPort PlacementHow do you administer your cloxacillin IVTime changing valves on Central linesmaintaining competencyPICC and PacemakersRemicadeScreen cover for Sonosite S-NerveHow many sticksSterile vs Non-Sterile Gloves for PNvote for the AVA electionMIDLINESMIDLINESdrawing ABGs from wrist of the arm with PICC; h/o mastectomy in the other armWarning about multiple uses of a single dose vialsub-Q discsSepsis bundle, PICC vs tradional CVC placement?Assistance with patient assessmentNursing home management of PICC'sSwabcap and Curos...all IV lines (CVCs and PIVs)?Continuous infusion of NafcillinBBraun Introcan Safety 3 catheterplacing picc on pt with recent admission of ivdu Port dressing diaphoretic child2 RN PICC placementLab draws from PICC Advantages of having 2 RN on CVC maintenance bundle by CMSquestion about standards of practice 2011question about standards of practice 2011Med port accessIV Teams Defineddihydoergotomine (DHE) PICC exchangeargatroban Antibiotic Lockinghemodialysis catheter cuffPending Blood CulturesCost of Vasonova VPSlab draws from central linesPICC tip confirmation of placementTPN & Needleless Connectorsprocess measures and outcomesExcess antibiotic solution in tubingSAGE 2% CHG Bath clothesWhat the INS standards midline and CVADFrequent doses of TPAfibrin versus vegetation on PICC tip , how to differentiate?Ultrasound Guided Peripheral IV practice guidelinesPICC BrandsAdministration of fibrinolytic (CathFlo) through implanted venous access device (Port-a-Cath)trombosis risk during flightPersistant Left SVCpower vs non-power ports-repostTegadermLynn - tubing questionPIV Insertion trainingPICC insertions without stylet wireRay-Marshall LineGuard Catheter Shield for tunnelled Groshongs and HickmansDeclotting hub to hub vs through a new needleless connectorPeripheral AmiodaroneDressing changes for CVC - Subclavian, Jugular, Swanz CatheterBuzzy-to offset pain for pediatrics with PIV'sGuide wire lengthECG PICC tip confirmationLooking for the National Average for PICC placementsecurement devices and sterile dressing changesCentral Line Flushing questionHospira Propofol Injectable Emulsion: Recall- Glass Vial DefectPICC TeamsLocal cellulitis treatmentLPN role in central linesIntrathecal/Epidural site careleaking at connection between line spike and infusion bagMidline insertion with max barrier Admission CXR for PICCsOrientation to IV TherapyIV Attempts - What's the Expectation?IV Line Set Up StandardizationTherapeutic Phlebotomy CompetencyPRN PICC Nurses neededLeft side approach PICC insertion, or non-dominant armThe JC EB guidelines for preventing CLABSILeaving PICC as midline, safety concerns.temp femoral linesAVA Pediatric TrackMD placed central lines going in juglar and Dr gives ok to use linespamInfection Risk Subclavian vs PICCCathflo consent?Gloves when delivering IV therapyDevice SelectionHow many PICC insertions to maintain competencyIV access perfromed by PICC TeamInfusion PressureDialysis InformationPhlebitis policy neededIVIG administrationRemoval of all supplies from boxes? JCAHO requirement.Removal of CVC/PICC procedure questionVital signs before and after medication administration Literature supporting injection cap changes?parental nutrition osmolality standards different for ASPEN and INS, what does a facility do? filter use for patients with PFOs?More than one peripheral IV catheter in the same armPowerglideContinuous tubing hang time - surveyImplanted Port - Access/De-access P&Pdrawing lab from central linesVancomycin extravasation & Hyaluronidaseterminology for IV access devicesout-patient picc placementsTime between flushes on temp unused PICC line?Marcia Ryder double skin prepping techniqueTiming of declotting linesRecent info at AVA from Dr Thomas P. Nifong, MD; need help with resource on treatment of thrombosis related to PICC linesChanging PICC over wire.PICC drsg for sensitive skinNursing orderLeaving wires in PICC'sEthanol LocksGuidewire stuck in armCatheter DaysRotation of IV sites based on clinical indication.Statistics on how many PICC and Central Chest lines are placed? Fungitell assay (D-glucan assay)Ultrasound guided venous access CPT codeVasoNova informationJoint Commission requirementNational Level Datacentral venous catheters and Aqua rehab; CT techs injecting in CVC linesUltrasound SystemsTransfusing Irradiated blood productsNeed help with ultrasound guided peripheralsVasonovaInsertion siteslegal documentationHow do you secure a triple lumen catheter, placed in the internal jugular on a pt. w/ Stevens-Johnson syndrome?Blood draws with initial venipunctureLignocaine strength for PICC placementCentral lines/PICC lines that continue to bleed after pressure appliedWhat is the standard practice for starting IV's in the breast area?Midline insertion max barriers or not ?Ecchymosis a week after insertionrisk versus benefit for PICC line versus MidlineBedside RN discontinuing PICCPolicies for Nurses placing CVC'sSecurAcathCardiac Infant PICC lines lower extremitiesVenipuncture in Extermities with limited sensation or movementMidlines and using if blood return not presentCT scan power injection and PIV site/size requirementsAlcohol disinfection capsChanging IV sites for vesicant chemotherapyHuber Needleblood draws off CVCs2 inch huber needlesMedcomp portsbiopatch with Port-a-caths?CKD/ESRD PatientsNeonates/Ped blood conservation/blood samplingsilverlonIV therapy research topics-need suggestionsPeterPICC vs Blue phantomSpecific site documentation Sodium CitratePIV and blood returnFever 3 weeks after chemoFever 3 weeks after chemoCathflo & Chloraprep versus alcoholA new POLY MIDLINE catheter by BARDDocumented Competency For CVAD RemovalHow many nurses does it take to remove a central line?Could you take 20 minutes to help a student design a better vascular access device?Outpatient required info from ordering doctorStem Cell HarvestNew blended learning opportunityBeds vs FTE's vs Hour of operationSwab Cap Evidencetrouble with deciding warm or cold compreses for extravasationsFlushing arterial linesConsentsOld journalsOverwire central line of burn patient days 3, 6 and 10Power Glide Midline questions for those already placingUse of positive pressure during non-coring needle withdrawalArterial line in axillaHappy Thanksgiving and Goodbye for a few daysheparin flushTego capsPort-a-cath deaccess questioncentral line bloodstream infection insertion vs maintenanceInformed ConsentOpportunities to get publisheddiscussion with pharmacist re:back flushingCVC questions for neonates and pediatric patientsTime management for picc placementReadmission PICC xraysover wire picc exchangeImplanted Port Management as intermittent deviceantimicrobial pads/biopatchWeird port issuePICC complications after hourstubing changes with restartsmidline billing and ordersInsertion Site locationPH of drugsAdministration of multiple first doses in the homeHang time of IV fluidsMidlines & Picc Lines and Weather TempsContinuous chemo infusions - irritantsVessel Dilation with Nitropaste for PICC placementScrub the Hub and Dry ITblood collection from CVADCourses in ultrasound guidanceCALL for PRESENTATIONS FOR AVA 2013New way for radiologists to describe tip location? List of Vesicant Medications"Emergency" IV accessTech on your IV team?Mosby as policyTransporting Lido and NS in carNew court ruling on off-label marketingGuidelines for vasoactive medsAssessing patency of cvadEthanol Locks and frequent use of CathfloVisual Infusion Phlebitis ScoreVolume Controlled Devices, i.e. Volutrol or BuretrolPICC team, IV Team or Vascular Access TeamLVN'sLabelling of Parenteral IV SolutionsHolding PICC for bacteremiaPowerWand or PowerGlidesReaction to CHGCLABSIiv stabalization devicesProfessional insurance for PICC nursePotassium ConcentrationOnline journal clubPICC Insertion in Arm with burns/skin graftingPhysician office billing for Nurse placed PICCPICC retractionsclamping lumens on cvadCentral Line Site care2" Huber NeedleIV Nurse Time/Function Averages?Use of Solo PICCburetrols for pediatricsDextrocardic patient with PICCFrequency of PICC tip verification xrays for patients on TPNTego needleless connector for hemodialysisProper way for flushingMoving your PICC Team toward insertion of Internal Jugular PICCsCardiac Embolism and PICCsCardiac Embolism and PICCsNursing CVC Consent FDA Meningitis Cases1 inch vs 1.25 inch peripheral catheterIndependent PICC insertion company contractsPeripheral IV infiltration ratesIV push techniqueRemoval of PIVRemoval of PIVPICC line discontinuationorders to use piccTell me your thoughts about this PICC film Power Injectable MidlinesFemoral LinesFirst Dose in the HomeMidline and extended dwell cathethers - placement in the homeVenofer extravasationVenofer extravasationChanging IV tubing for new CVLPost-discharge PICC line thrombus rates?Midline placement and use?How long to put infusions on hold for lab draws??Do you use Long axis ultrasound PICC access or short axis guidance?Help with wording for IV Team job descriptionIV Team orientation packet helpNew forum member.... Hi all DVTBard triple lumen HF cathMedical IV team MissionMedical MissionTransfer of PICC'ed pt. How do you document your data?Securing Lines and caps for PICC and Central LinesCVP monitoring through triple lumen power PICC (BARD)Happy IV Nurses Day to everyone!!IV Insertion Kit ContentsAntibiotic RotationRemoving a nontunneled dialysis cathRoutine blood sampling from CVAD (yes/no)?IV Infusion PumpsHeparin flush free?pneumothorax on CVC insertion hits CMS never listTherapeutic phlebotomy via porta cathWitnessed the worst PICC insertion of my lifeSeeking information on Centrally placed PICC caths in distal subclavian-axillary siteDVT in cephalic vein of left arm and PICC in left brachial vein.Changing PICCs for suspected central line related blood stream infectionsDwell timesDisinfection of ultrasound probesProcedure carts in isolation rooms?Phlebitis scaleradiology techs and central linesPICC trimmed as midlinePowerGlide"72hour" tubingIJ ProctoringMalposition of the day?CVC Dressing Changes using a sterile gownMidline insertion and Full body drapeZosyn extended dwellDVTs and removing catheterdrawing labs from the PICCpulling back picclines in the right atriumECG Tip Placement "trumps" xray reading?Small Vessels on UltrasoundHelp-Contact hours for Online Journal Club??PICC lines and crutchesScratches with use of Chloroprep FreppNew guidelines on ChloraprepCRNI Recertification Units for LHA online coursespriming line and allowing flow to drip on floorCRNI vs AVA certificationPower Glide (Midline)Anatomical locations for peripheral IV placementsAmiodarone related phlebitisNeed help with on call criteriaCathflo shortageIM Injection in extremity with PICCOJC Ready - Saline vs Heparin for Locking CVADsBD PosiflushCreating an IV teamcalculation of device (PICC) daysVascular survey questionsIs this true? 15% of the veins that a PICC....Does anyone know of a policy and comp for using ultrasound for Collecting ABG'sTo nick or not to nick................persistant occlusion implanted portExtended Dwell PIV catheters and Midlinestransfusion via midline catheterSevenex consulting group~ has anyone heard of them~ looking at IV practicesPush-Pull for lab draws from central lineuse of soft restraints during PICC insertionPICC Lines (proximal, medial, distal)Attn: EPIC usersSilverlon Antimicrobial Dressing/Disc Studies as requested...MicroclavesBlood Culturescharge codes for PICC placement with ultrasound neededI'm Curious- Do you allow nurses assistants to remove PIVs?Ambulation with a Femoral LinePhysican order to use a VAD CHG swabs vs CHG sponge applicatorsPICC lineswhat should infuse through which lumen?Update on SwabCap and CurousBlood sampling below a PICCpre-procedure timeoutNeedless connectorsOJC - Saline vs Heparin for Locking CVADsPediatric Blood AdministrationContrast InjectionWhen do you change caps when blood cultures are drawn from a Central Line.CVCC removalRecall of Magnesium SulfateHuber needle; silicone or not?SiteRite VisionFrequent PIV sticksThey bought us an ultrasound !filter needle useCosts of IV suppliesDialysis fistulas and use of ultrasoundQueries for anyone willing to answer!Biopatch on Port-a CathsSherlock IIGlobal PIV assessment dayGlobal PIV assessment dayContrast warming or not?Contrast warming or not?Following INS Standards of Practice ( is it really necessary or important?) Extravasation Protocol ; drawing blood cultures from CVADPOWERGLIDEGuardIVa vs BiopatchIcreased risk for infection in clotted linesIcreased risk for infection in clotted linesAdvanced practicePort a cath flushesmost interesting reaction/complication/potential complication?pressure injection into 22G PIVTechnique for accessing implanted portsPICC RegistryUsing PICC lines for blood draws for labs relevant to Sepsis screening and monitoringlength of time risk of air embolism is present post line removal and day #2 and day #3 dressing changes Lifeshiled neutronSHEA Practice Recommendation- PICC placement should be observedBIVIGAM Recall announcedPICC Declot Blood draw from midlinesClosed-glovingPower Injection and CVAD Tip Placement VerificationChoosing the right vascular access deviceHas anyone been requested to do CVP readings vis indwelling chest ports? PICC related Thrombosis managementPIV NumbingEdwards Multi-Med Pressure Injectable CVCPeripheral IVLiabilityHospital Policy and Procedure for PICC placementsPlease help with a surveyTrouble shooting portacath24 hr PICC Service?Is there a CPT code for a PIV placement under U/S guidance ? Can it be billed for this procedure? Thank you in advance.tip verificationOPENING STERILE KIT FOR PICC INSERTIONintroducer insertiondisclosure of affiliationvotingBlood Samples from Central LinesNew Angiodynamics catheterExternal Jugular Peripheral IV AccessTunneled PICCBard Site ScrubConsent for PowerGlidePICC clinicians neededIntraosseous AccessPI Project Suggestions for Vascular Access Team3M tegaderm dressingIV tubing in OR settingEmergency access on Dialysis patient in ER ultrasound PIVFrequency of site checksBlood draw per INS standardsStarting picc line business Overriding consentUse of BioPatch in Pediatric populationCXR & arrives with a PICCProtection of skinTJC compliance and dedicated central line cartAbnormal Calcium blood levels from central line drawPICC line related DVT preventionBlood Sampling from Peripheral Catheters - Online Journal ClubCap ChangeLength of time a vesicant can run peripherallyHot or Cold Packspulmonary artery catheter removalNeutron capBroviac/Hickman Repair# of IV Therapy TeamsTracking DVT rates for PICC lines criteria/guidelines?Cathflosecondary flush bags for antibioticsAir EmbolismMRI compatible infusion pumpNurse Driven IV insertion protocolsFrequency of Vital Signs during Blood TransfusionsWhat is your opinion..Power injectable portsDrape under the arm for PICC procedureKCL infusionFlushing policy Heparin vs SalineIs anyone using EPIC as the EMR? Intraosseus policyChanging peripheral access sitesPolicy for RN's inserting EJ IV'sadministering controlled substances IVpermcath removal at bedsideFrequency of flushing dormant cvadsHome IV antibiotics through any type of CVC, gravity drip or infusion pump, what is the standard? Increased CLABSI when blood samples are obtained from a CVCFLUSHING CENTRAL LINESPICC nurse job descriptionPicc placement for Hickman removalperipheral IV skills checklistTherapeutic phlebotomy with CVAD's.CHG NAD wipes and clotting issuesrecommendations for chg concentrationPower Injectable extension tubing Bio-Flo piccinvoluntary blood back up in PICCDe-airing IV bagsCold Pitocin infusion causing painUse of an infusion pump vs GravityBlood cultures from central venous access devicespressure dressing to a PICC insertion siteMidlinesPICC REGISTRYChest X-ray for Port-a-cathBARD PowerGlide midline catheterFabrazymePort Access - wear a mask or not?Alcohol pads and sterile end caps in acute care patient rooms.Yearly NVAT goalsmax-plus end caps coming off the lineIV Device for filtering airBard PREVUE ultrasoundsPICC insertionSecurAcath Changing PIV sites that have been started @ another facility or by squad personnelChevronTherapeutic phlebotomy and AV fistulaswitch from Chlorhexidine gluconate to alcohol swabsHeparin Flushing of TLCcross campus vascular access teamDisinfecting port protectorsocclusive dressingNeedle guide versus freehand placement of PICC'sHuber needle sizesInfusaport flush on a pt. with HITNeutron ValveSecuracatharterial puncture as result of attempted PICC placementLength of time stopping heparin IV/ TPN for blood drawsDeaccessing portacath Osteogenesis Imperfecta and PICC PlacementTPN using PortDrawing labs when starting an IVArizonaXolair injectionHyaluronidase dosingPRN IV StartsLong LinesEmergent PICC placementThis may sound like a dumb question but ....Old implanted portsDocument on assesment process for potential PICC pt.Isopropyl Alcohol versus Chlorhexidine Gluconate w/Isopropyl Alcohol for disinfection of Needleless ConnectorsCRNI study books for sale??Intermittent subcutaneous injectionScrubbing the hub between flushesHow much Heparin to lock a port Anyone using SecurAcath???Cost of PICCs at bedside compared to IRBARD Solo PiccsPICC lines in weakened extremities due to CVAmaking a PICC a midlineObtaining consent for PICC placementAspirating Blood with PIVProphlactic Alteplase in Pediatric Broviac'sClear Neutral Displacement Needleless Connectorspulling a PICC through an occlusive clotUse of positive pressure connectors on arterial sheaths and arterial linesNovocath Secure IVre PICC RN doing 'Informed Consent' for PICC Insertion in CalfiorniaHandling Biologics while breastfeedingso you print any photos for documentation of your picc line insertion?CENTRAL LINE AND PICC PROTOCOLinsertion related clabsiChecking for brisk blood return.Culturing PIV TipsFull Time IV/PICC Nurse Chester County HospitalSudden and severe loss of Janet PettitHow do you track phlebitis at your facility?Who has done product evals on BOTH 3CG and Vasonova?Rate limit and combo of drugstherapeutic phlebotomy via a portweekend coverage?Going to AVA? Seeking roommateIntra-Articular Antibiotic infusionVascular Access Device and IV therapy IV Pump NoiseNeutral Displacement ValvesPicc insertion classestrouble logging introuble logging inStatseal discUse of IV catheter extension setsImplanted port intermittant flush when accessed in a hospital setting.Locking solution HeadlineCXR on admission for pre existing linesPIV below old fistulaCubicin lots recalledGowns for PICC insertionConcerning BioPatchpractice questions re renal patients, SVC graft and pacersIPA in catheter hubs?One vs two person PICC teamsMidline cathetersLabeling of venous access devicesDrawing from a MidlineMidline Catheters: What, Why, and When, a new online CE coursePediatric Infiltration/Extravasation Scaleclave vs microclaveSite Scrubplacement of peripheral IV'sConsent for midline cathetersVein ViewerPICC REMOVALCRNI ExamPIVI need a software program for my PICC nurses to chart electronically and be mobile in different facilities...HELPDocumentation of peripheral IV assessmentMidline Catheters like or dislike?Staffing for PICC InsertionsINS Infiltration scaleIntermittent IVAB to Saline LockPost Dialysis Use of Hemo/dialysis CatheterNeutral Displacement caps decreasing infection ratesPotassium ChloridePeripheral IV cause valve damage?Portacath Insertion - Care of site and use post insertionCompatiblityAlcohol impregnated capsLidocane recallTip Positioning QuestionsCiting from "Infusion Nursing Standards of Practice"Problems getting to discussionTech placing USG-PIVAnyone having trouble getting onto the website?Root Cause Analysis (RCA) template/format for CRBSIVascular access toolUltrasound techs placing PICC linesBlood return to check patency of lineInsertion site prep for CVAD removal with tip culturehepgtt and NS fluid at 100cc hourCefepime Recallquestions about UE DVT and # of lumens/infection riskLocal anesthesia for periperal IV insertionsHospira recall of Metoclopramide and ondansetronDrawing blood for vanco trough from a portacathAlcohol capsPIV check frequency Multiple lines in SVCSafety of discharging a patient with a non-valved PICC or central lineLooking for IV certification class in San Francisco Bay AreaPH of solutionsQuestion about the 3CG systemAssigned Day for PICC Central line dressing changes vs every 7 day rotation Extravasation policyTime for skin cleansing for peripheral IV startsCentral Line Flushing with Normal Saline OnlyDuoderm under sterile dressingBlood clots in upper extremityDressing for CVADSPhoto of CVAD cartiodine and alcohol: Is there an order?Reducing tubing disconnectionsImpregnated Discs for CVC dressings/sitesPIV below HD fistulaSingle-inserter procedure questionbuffered lidocainePICC line placement above non functioning AV fistulaUltrasound Guided Vascular AccessInfusion rate for FFPperipheral iv startsIV Stabilization for pediatricsPICC placement how high up the arm is safe to go.Coverage for PICC line nurse: train another or contractpriming of caps with cap changePICC DCend capsArticle references against placing PICC in quadriplegics/stroke patients persistent hiccups in a patient with a PICCMAHURKAR, triple lumen, dialysis catheter.Tripple lumen catheterspostmarket surveillance study on positive displacement needleless connectors Assessing for Upper Extremity DVTBest Practice for PICC placement in non-mobile arms-Lynn Hadaway...are you out there?Two Nurse Vascular Access Teamsdrawing blood from a central venous access devicedrawing blood from arms with nonfunctioning fistulabilateral mastectomiesEthanol Locking PolicyPICC during surgery...Rationale for no IV access on PICC ArmExtended Dwell Peripheral IV CathetersSizing PICC to vesselTPN and infectionBAXTER One linkPowerglide midline catheterneutral needleless connectorcxr and cvad occlusionsVascular Access teams placing arterial linesPIV designIVAD accessIV Securement: Devices vs. Dressings PICC Dressings when skin reaction occursspastic patientPCA tubing changes Home IV Therapy Nurses - Heparin and Saline flushes in extra suppliesRemoval of tunneled piccsHappy Holidays - Spread the Wordsite scrubBariatric patientsFlushing and locking requirement for multi lumens CVADTPA and NADEliminating CHG from PIV start kit as a cost saving measureAssessment frequencyPowerpicc splitsPlacing PICC in healing burned arm?Ethyl Chloride use in PIVNo chest x-ray for alteplase or other unblocking protocolHeparin free flushing protocols2nd dose of cathfloRN Arterial line insertion Texastaping cvad connectionsStarting a vascular access program...need your helpIV Tubing-Transfer from UVC to PICCPre-flush before withdraw of blood specimen from VADDo you scrub the tint off the arm after a PICC/CVC? & trouble with 3 M PICC/CVC securementUS guided PIVClamping Secondary med set for atb infusionAV fistulaMIDLINE MISUSEGreenfield IVC filterTPN Mix recall--May see shortagesPiccs for pediatrics Less than 2 y.osize of non coring huber point needle for transfusion of blood productsThrombosis caseBreaking the line to draw bloodupper extremity ischemiaNew Position-IV Nurse Educator/ Clinicianphenergan IVIV Team Resurgence and Lobbyingclosed systemArterial vs. venous PIV placementreposition vs wire exchangeChanging peripheral IV's only when clinically indicatedDoes anyone know the source of the pH and osmolarity chart?Labeling IV administration setsPicc insertion for patients with vegetation on heart valvesheparin drip with heparin pushPICC consentSherlock 3CG & VasanovaTeachingPICC in healed burned areaDocumentation of Fluids in a multi-lumen lineCADD SOLIS pumpUltrasound Guided PIVHelp! What statistics do you keep??? AND Happy IV Nurse's Day!Team vs Solo PICC insertionLooking for a Vascular access Job.Clin. Indicated PIV removal = decrease in staff?Powerwand VS Powerglide?Peds picc insertions on patients <2y.o.Forgive me this foray into semanticsPlease help us define a midline catheteroutpatient requests for flushing CVADhaving pts deep breath while accessing portthrombus noted in picc arm but.....NOT in picc vesselBacteriostatic water for localcathflo and portsExtra IVF with secondary infusionsNeed advise asap please!Bubble FiltersPediatric epidural--help!Occluded ports in a CVADPICC line admitted from another facilitySodium chloride 3%Blood return on PIV before medication deliverypatient identifierPowerGlide MIDLINE chargeIntermittent antibiotics in minibagPICC tip placement in pediatric patientsPower Glide in PediatricsBackpriming of secondary medicationsNeedleless ConnectorsultrasoundUltrasound guided PIV insertionsCXR for PICC tip confirmationRadial sticks Documenting total length of trimmable PICCWhen to re-xray?How to determine if CLABSI is related to PICC insertion versus maintenance?PICC insertion miss x4 same MDVascular access devices and blood returnuse of restraintsCT, MRI & radiology techs accessing implanted portsLimb Alert Bracelets: looking for policySeeking research resultsCathfloTasting salineExtension Sets and PICC linesTamper resistant caps/needleless capspulsating flushesVesicant chemo thru implanted portLiterature and opinions requested: Teaching patient port access and blood drawsIV Magnesium in the homepicc tip in right atriumfree hand VS needle guide picc insertions. Videoconference presentationsInfusing Hypertonic Saline through a Peripheral Line versus a Central LineHeparin dose for pediatric mediports/port-a-cathsStatseal dressing change frequencyTime to perform alchohol scrub Aspirating HepLock from Port prior to usePositive Displacement ValveCRNI Recertification Units from 2 of our online coursesTPANormal Saline Backorderpicc vs hohnPICC and an SVC filterBlood Cultures/Central lines with triple lumensEfficacy of Chlorascrub(TM) wipe vs alcohol wipe for disinfecting needleless connectors/injection ports therapuetic phlebotomy suppliesHickman and PICCFlushing between ambulatory pump antibiotic bagsDwell duration of SPC getting the CVC cap/Needleless access cap off a CVCTPN Tubing Change with LipidsAspirating CVC/Syringe size safetyMidline cathetersThrombi Disc, topical hemostat (has hemostatis and antimicrobial)Insertion of spc in breast tissue vessel20 mL for saline flushingParalysis & PICC insertionsElastomeric problemsProcedure TimeoutMalposition PICCLocking infusion ports with sodium citrate 4%Port-a-cathWhat is your hospital doing for Early Assessment of the right Vascular Access Device?INCOMPATIBLE MEDS THOUGH DUAL LUMEN PICCBlood Transfusion administration concurrent with IVF and medication via dual lumen PICC lineadditional tape on central line dressingsOcclusionschanging picc to midlineextravasation in outpatient CTSiteRite 6 and documentationDouble Oblique trimmingCVC catheter securement ?New bag and new tubing for newly placed central catheterMidclavicular CathetersBlood draw from central lineCompliance with labeling IV tubingCXR "Reading" classes for RN'snew article posted on IV TeamObstacles and barrierscleaning dialysis catheter hubsChanging cap/connectors to the hubs of CVADConsent for Blood TransfusionAlternatives to LidocainePICC initial placement CXRProgressive Vascular Access/Resuscitation TeamBlood transfusion via indwelling CVCDEHP FreeDuration of PICC LinesPICC Teams that are placing IJs/Dialysis catheters/Art lines/PICCs,etcAlcohol impregnated capsTrouble with email and change of addressLeaking second new PICCprocedure situationsDoes anyone allow staff other than nurses to access implanted ports?Nexiva IV CathetersUpper extremity DVT in cancer patients with PICC linesPICC Coordinator RoleNeedleless ConnectorsPICC lines in the ORDeclotting AV Fistulaswarm or cold therapyUse of alcohol to dilate veinsFlushing CVC with less than 10ml normal salineHome Infusion of RemicadePicc tip flipped up in jugularSkewed lab results from PICC and CVCsBlood Cultures PICC Neonatescharging for ultrasound guided access with bedside piccsJob Descriptionwritten anaphylaxis protocol Products to assist patients with Central Venous Access DevicesStop cock method of de-clotingKeeping IV catheters in the LTC residentCXR and RespirationPower CT InjectionD5NS Solution ONLY thru a midline catheter?Insert wire to SVC vs "Nurse" insertion of PICC with wrie more shallowIV Push meds given directly into vein vs starting indwelling PIVretro flushing methodCVC dressing interuption Measurement scale? safe administration of vancomycin through a novel midline catheter a randomized prospective clinical trialBlood cultures and placing aPICCEVD dressing Pt with picc line and portClinically indicated peripheral IV site changesnational averagesPlatelet count and PICC removalTPN, 0.9 NaCl hydration -dedicated line required?Dalvanceguidewire PICC exchangeAbnormal VasculatureScrubbing the hubAccessing a newly placed port with steri strips in placeFistulas and peripheral IVsverification of picc tip location on a prehospital piccPIV blood drawsPediatric VAT in a Children's hospital with in a hospital.Femoral linesSterile sheaths for Site RiteVPS P&PPort w/ Fibrin SheathAlcohol capscompetenciesStarting PICC companyvascular access selection algorithmultrasound guidance mandatory Giving IV Push med thru a continuous infusion setMIDLINE consentPort flushesclamps on the extension setLearn about PICCs and Ultrasound PIV'sInitial Rate of Blood AdministrationDoctors ordersre Arterial line placement on Mastectomy side"Do Not Do" PICC placement listPlacing PICC New Pacer MakerPICC/IV team RN staff getting consentfor PICC insertionsaline lock tubing on peripheral, intermittant use IV fluidsIntermittent Infusionsraynaud's and PICCsdouble lumen portPharmacy questioning my volume /amount of useage of Cathflo....need inputOutpatient linescentral line maintenance bundleLost wire/ need help and literatureLost wire/ need help and literatureBenchmarking successful IV StartsInsertion of PICC on restless/hallucinating patients that may require 2 PICC team members.dobutaminePICC/CVC securement devicesHelp SupportSiteScrubMeasuring and documenting length of central line catheter inserted and length exposed.Octreotide/Protonix dripsPICC guidewire getting sucked in to patient's veinPIV T-Connectors/Extensionsdiscontinuing central lines, IJ or subclavianEKG for tip population in the pediatric populationMaxium barrier precautions. Hair covering skull cap vs bonnetCubicin RecallExtravazation policiesUse of PIVs in the same arm as PICC linesSkinprep...Arm Circ. needed? or history?Coiled tip in brachiocephalic veinpicc contraindications for arms that are post-op (hand) & infected?Flushing and checking patency in a continuous infusionBackfilling when Declotting Dialysis CathetersPicc Updateantibiotic ointment use for central line removalOver the wire exchanges in blocked single lumen PICCPediatric PICC placement Powdered Glovescovidian needle less connectorCHG Allergy and BioPatch alternativeDVT and picc removelpicc line - port occulsion and CXROn call for PICC placementBard flush recall on PICC TraysDVT both sides, what to do for venous accessCover LetterDiscontinuing emergency IVIJ PICC dwell timeColor-coded tubingSQ Lidocaine with PICC PlacementDo other PICC teams use two nurses to measure for length?Sapphire PumpAVA voteIntra operative PICC useSOS.......... Need help building a teamCentral lines versus PIVWhat is the best practice for changing or not changing the caps on PICC line when hanging TPN?Best practice for PICC blood drawsMidline Catheters for Vancomycin? Videoconference discussionsupport articlesDressing changes for PIVMidline insertion questionS, now that many have been using for a while should get lots of infopeds/neonate flushPhlebotomists with ultrasoundList of PICC catheters/Midline cathetersSOLO PICC 2 Trialysis CatheterNurse driven PICC teamsPort CompetencyUltrasound training/competancyTricks/tips for stubborn PICC advancement?Midlines and ICD 10 codingvascular access teams in the EDPIV vesicant infusions in the homearterial linesPharmacokineticsChanging administration sets with least amount of lost medication doseDVT alorithimDifficulty in threading guidewire once vein cannulated.Central line need assessmentViaValve catheters from Smiths medicalpediatric vascular access/I.V. 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We are well aware of the IV tubing change recommendations by the new CDC guidelines. We are also aware this issue has been discussed at many IV listserves recently.

But we would still like to know the standard of practice of TPN tubing change frequency in other hospitals. Please respond to the following questions:

1. How often do you change TPN tubing if it is y'ed with intralipid close to the catheter hub?

2. How often do you change TPN tubing which is directly connected to the catheter hub or y'ed with other stable solutions (not intralipid)?

Thank you in advance for your answers.

Toshi Holland

Children's Hospital & Research Center Oakland

Forums: 

 Karen, it would appear to me that your change on Mon-Wed-Fri increases hub and tubing manipulation, thus increasing the risk of contamination, colonization (aka biofilm formation) and infection. I am curious as to why you did not choose Monday and Thursday instead which would seem to serve both staff problems and manipulation problems. 

I think the original message was actually addressing an issue that has been studied very little with IV sets and PN/lipids. When the lipids are piggybacked into the PN set, or when the lipids are infused through one lumen of a multiple lumen extension set, the lipids are in contact with a small set of the extension set that may not be changed on a daily basis. The question is then, if lipids have been exposed to any portion or segment of the entire system, does this mean that the entire system should be changed on a daily basis? If so, do we reattach the PN set to the new extension or change all sets every 24 hours. There is only one reference examining this issue, listed in INS SOP, page S56, reference #7. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

In our Hospital we currently do the following:

1.  Lipid lines are changed every 24 hours - irrespective of where they are sited - this includes the 3-in-1 solutions

2.  Clear fluid PN lines are changed routinely if the PN is on continuous infusion - every Monday, Wednesday & Friday - although CDC guidelines recommend 96 hours - the practical application in the clinical setting is far more challenging - anecdotal evidence told us that lines aren't always changed when they are meant to be - the risk was too high to allow therefore we chose to use these days of the week to ensure there was some regularity and increased staffing in areas where patients are big users of PN - e.g. Oncology.  So what we did was take a risk management approach to our policy/guidelines.

If the PN is started on any of the days outside of Mon/Wed/Fri then the line change occurs at the nearest day to bring them into the routine cycle - this has been in place in our Hospital since we undertook the systematic review back in 2002ish. 

We too change the PN solution every 24 hours.

 

Our cochrane review on timing of line changes certainly allowed us to change our practice but also highlighted to the clinicians across the Hospital that the more you change and "fiddle" with the lines the greater the risk of infection - it is hard to argue with the evidence.

 

cheers.............. Karen

Karen Rankin

Clinical Nurse Consultant

the Children's Hospital at Westmead - Australia

Toshi:

  I just spoke to a NICU Nurse Educator I know at Chilldren's Hospital of Atlanta.  If the have TPN and Lipids y-sited together into the same line then they change the entire set-up down to the hub every 24 hours.  When they were not doing this they noted a higher CLASBI rate and thought it could have been the lipids left in the y-connector that were causing the problem.  Their hospital is an IHI mentor site for Central Line related questions so trust their judgement on this issue.

Our NICU plans to keep with a q 24 hr change as we generally have TPN and lipids y-connected into the same line.  Hope this helps!

-Patti Laliberte, RN, MSN

Pediatric Clinical Nurse Specialist

NH Hospital for Children

Manchester, NH

I would also like to know what others are doing in regards to this practice change.  In our NICU and PICU we often have TPN without lipids running which per CDC/INS would mean a 96 hour change, which many of my colleagues feel is "icky" and want to keep the 24 hour change we have been practices.  I do understand that the purpose of the 96 hours is to decrease breaking into the IV site.  My Pediatric Phramacist pointed out that we change the TPN bag daily and that often addtives are changed daily by the provider.  In the NICU and PICU the TPN is often going at a low rate so it would take a while for the tubing to be cleared of the "old TPN" formula, so is that is a concern.  If lipids are ordered separately they are often y-into the TPN, so there is mixing of the TPN and lipds in the y-set, so I would also like to know the answer to the question you posed in #1. I certainly want to adhered to evidence-base and best practices but there are some valid concerns posed by NICU and PICU colleagues that I feel need to be addressed before we consider moving to 96 hours.

Hope others with answers will comment! I posed this on my advance practice AACN listserv-I will let you know if I get any info from the group!

-Patti Laliberte, RN, MSN

Pediatric Clinical Nurse Specilaist

New Hampshire Hospital for Children/Elliot Hospital

Manchester, NH

 The standards committe had lots of discussion about your #1 question!! Reference #7 on page S56 of the standards is all we could find in 2009-10 when we were doing lit searches. I am not sure if there has been anything else published on this issue or not. I am also eager to hear what others are doing about that short segment of extension set that is exposed to IVFE. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861