PBA: IV Insertion

Question 1

1st: REVIEWING ORDERS AND GATHERING SUPPLIES NEEDED

Answer 1

@ recieve report from off going shift
@ (outside room) checks EHR for LEGAL order to maintain IV access
@ Gathers IV insertion supplies (IV catheter, IV start kit, extension tubing, normal saline (NS) flush, waterproof pad, extra alcohol pads, tape, and gauze.)

Question 2

2nd: EXPECTED PROFESSONAL BEHAVIORS

Answer 2

IPOWER
@ Student nurse enters room and introduces self, explains they will be caring for patient, and they need to assess the patient’s IV site due to a report of pain.
@ Obtain consent, provides privacy
@ Performs hand hygiene in front of patient
@ Identifies patient using two patient identifiers, physically compares physician orders to wristband. Identifies allergies

Question 3

3rd: SITE ASSESSMENT

Answer 3

@ Raise bed to appropriate working height. Places waterproof pad under extremity to protect linen
@ Hand hygiene, applies gloves
@ Assess IV site (visually inspect and palpate) and identify need to change IV site due to infiltration/phlebitis. Explain IV condition and procedure to patient

Question 4

4th: PREPARATION OF EQUIPMENT AND PATIENT FOR IV REMOVAL

Answer 4

@ Ask patient, in terms they can understand, if they are on anticoagulants. (to determine how long to hold pressure
@ Prepares 2x2 gauze and tape, uses alcohol pads on skin to carefully remove clear occlusive dressing and excess tape. Folds 2x2 gauze and applies slight pressure over insertion site while simultaneously removing the catheter
@ Inspects to ensure IV catheter tip is intact, not “sheared”. Holds pressure and applies tape
@ Assess patient for any discomfort and educate patient when the dressing should be removed.
@ Disposes of used supplies in appropriate receptacle. Proctor may remove dressing.
@ Removes gloves and performs hand hygiene

Question 5

5th: PREPARES EQUIPMENT FOR INSERTION

Answer 5

@ Opens ALL necessary packaging, loosens or removes extension tubing cap keeping male end of tubing sterile
@ Using saline flush, primes extension tubing with aseptic technique, keeps flush attached.
@ Place extension within reach, on sterile packaging, keeping male end of tubing sterile. Removes extension tubing cap if not already removed

Question 6

6th: PREPARES PATIENT FOR IV INSERTION

Answer 6

@ Applies tourniquet 4-6 inches above potential IV site and places arm in dependent position
@ Encourages the patient to clench and unclench fist; requests for the patient to relax their arm Identifies vein for IV venipuncture.
@ Cleanses patient’s skin with Chlorhexidine scrub for 30 seconds then allows to dry..student does not touch prepped area

Question 7

7th: INSERTING IV

Answer 7

@ Hand hygiene, applies gloves; applies piece of tape to clean glove on hand
@ Remove IV catheter cap. Uses non-dominant thumb to pull skin taut 1-2 inches below the IV insertion site
@ Holds IV catheter at 15-20 degree angle with bevel up. Anchor vein below intended site with non-dominant thumb and insert catheter.
@ Observes for blood return (flash), then drops the angle of the IV catheter to 10 degrees or less
@ Advances the IV catheter slightly (no more than 50% of the needle) and then advances ONLY the colored catheter hub until it is at the venipuncture site in the skin.
@ Stabilize the colored hub with dominant hand by holding needle in place, OR with non-dominant hand pointer finger thumb
@ Release tourniquet
@ Occlude the vein above insertion site with ring finger on nondominant hand, being careful not to contaminate insertion site. Secure colored hub with non-dominant hand pointer/thumb if not already done
@ Activate safety feature to retract needle
@ Connects Extension tubing to IV catheter without contaminating IV site or bending/dislodging IV catheter
@ Applies tape to extension tubing for securing.

Question 8

8th: POST-INSERTION OF IV

Answer 8

@ Gently aspirate for blood return and then flush 3-5ml slowly with normal saline flush, simultaneously assessing for pain or resistance
@ Removes saline flush from extension tubing, closes extension clamp (close clamp while flushing)
@ Ensures IV site is clean, dry and intact before applying transparent dressing (use gauze or alcohol swab)
@ Applies transparent dressing completely over colored catheter hub, up to the clear extension tubing connection
@ Dispose of IV needle in SHARPS container.
@ Remove tourniquet completely from arm for removal from room
@ Clean up workstation/patient bedside
@ Removes gloves and performs hand hygiene
@ Labels IV using date, time, & initials
@ Assess patient for any discomfort and inquires about any questions or concerns
@ Places bed at the lowest level, side rails up x2, places call light within reach
@ Performs hand hygiene and leaves the room

Question 9

9th: DOCUMENTATION OF REMOVAL AND INSERTION OF IV

Answer 9

@ “at x time I removed IV catheter from x arm; catheter intact; I applied a new dressing, and pt handled it well.”

@ “at x time, I placed a new 22G IV in x arm, blood return visible, flushed easily. PT tolerated it well.”