In case you missed it, here’s a summary of IV tips posted on Twitter in February.

Central Venous Catheters (CVC):

• All CVC should produce a free flowing brisk blood return upon aspiration without having the patient do shoulder/arm movements.

o It is not acceptable if patients have to do shoulder and/or arm movements in order to obtain blood return from a CVC.

o If this is the case, there maybe a problem with the CVC and/or tip.

o Assess and identify cause. Read “Seeing Red” blog on possible causes.

• To aspirate and/or flush CVC, use a large syringe size (10mL) with the appropriate amount of flush solution. Smaller syringe size (3mL, 1mL) has a narrow diameter and exerts greater pressure (psi) causing potential damage to the catheter.

o There are prefilled syringes available with small amount of flush solution housed in a large barrel size syringe (10mL).

• There’s a problem if unable to get positive blood return from CVC, do not use the catheter and assess the cause.

o Read “Seeing Red” blog on what is a positive blood return.

• Apply a transparent semipermeable membrane dressing (TSM) and a securement (stabilization) device to CVC sites.

o TSM dressing allows visualization of site. The CVC dressing is not a securement device unless  the product is designated as both dressing and securement.

o Securement device allow stabilization of catheter to prevent movement.

• When caring for a multilumen CVC, remember to change all caps, even on unused lumens.

• BP should not be taken in the arm where a PICC is placed. Pressure exerted may cause damage to vein lining resulting in complications.

Short Peripheral IV (PIV):

• On PIV sites, apply a transparent semipermeable membrane dressing (TSM) and a securement (stabilization) device.

• • TSM dressing allows visualization of site. PIV site dressing is not a securement device unless product is designated as both dressing and securement.

• Securement device allow stabilization of catheter to prevent movement possibly reducing the incidence of phlebitis / infiltration.

• Blood samples from a peripheral IV should be obtained only at the time of insertion.

• Always include the number and location of insertion attempts in your documentation when starting a short peripheral IV.

IV Complications:

• Infiltration-inadvertent administration of non vesicant medication/ or solution into the surrounding tissue.
  • Use the infiltration scale from the Infusion Nursing Society’s infusion nursing standards of practice to grade the severity of infiltration.

• Extravasation-inadvertent administration of VESICANT medication or solution into the surrounding tissue.
  • Use the extravasation scale from the Infusion Nursing Society’s infusion nursing standards of practice to grade the severity of extravasation.
  • If extravasation occurs, manage patient according to organization’s policy/procedure.
  • Any incidence of extravasation should be reported to the physician and a report filed according to your organizations’ policy/procedure.

• VESICANT is an agent capable of causing injury such as blistering, tissue sloughing/necrosis when it extravasates into surrounding tissue.
  • If possible, avoid using a PIV access for a known vesicant agent.