These questions might be most appropriate for Lynn. I hope you can help me. We are doing a major overhaul of our PIV policy and trying to improve practice and there is much debate about what documentation is 'required' or 'mandatory'
(1) We currently DO NOT get an MD order to place PIV - if IV drugs are ordered it is presumed a PIV is required - is this a standard around the country?
(2) We currently DO require an order to 'D/C PIV' - is an MD order 'D/C PIV' really necessary? We D/C routinely for phlebitis etc but if a pt no longer needs their PIV should a written order be obtained?
(3) Currently PIV and Central lines are flushed with NS 10mls routinely for routine maintenance and assessment and administration of medications - these routine flushes are not documented in the medical record? Should they be?
Lynn I hope you can give me some clarity on these questions as all of these questions will be addressed tomorrow when our policy is presented to administration forum and your guidance with your expertise and background would be very helpful.
Thank you,
SOD
First and foremost, you should be creating organizational policies and procedures in accordance with the Infusion Nursing Standards of Practice. This resource can be purchased at www.ins1.org. This is the first document used in any legal case for evaluating the practices of each nurse in a lawsuit. Also, you should be in contact with your risk management dept for their input on these questions.
#1 Most hospitals allow an LIP prescription for IV therapy to mean that a short peripheral catheter will be inserted to begin that therapy. Currently there is a movement to prevent vein wasting and the number of venipuncture attempts could become an issue especially if it is excessive or causes complications for the patient such as nerve injury.
#2 The presence of any complications should be detected by the evaluation of the nurse and this means immediate PIV removal, no time to wait for an LIP prescription to remove. This removal should be followed by an assessment of vascular access and infusion therapy needs to determine the most appropriate direction - changing to another route, another PIV, or some other type of VAD. The goal now is to remove all VADS as soon as they are no longer medically necessary. So your hospital must address this for PIVs and CVADs.
#3 NS is a medication and should be documented, along with the assessment of the site condition and the VAD patency as evidenced by no resistance to that flush and a blood return that is the color and consistent of whole blood.
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861