Managing IV Therapy and Site Replacement - Term Paper Example

Name: Tutor: Title: Managing IV therapy and site replacement Course: Date: Managing IV therapy and site replacement Description of a practice Intravenous therapy (IV therapy) refers to the infusion of therapies directly into a vein. During my experience in the hospital, this therapy was being used when correcting electrolyte imbalance, delivering medication, during blood transfusion or for fluid replacement, for instance when a patient had dehydration. Before any IV therapy process, cleaning of hands and other necessary hygiene protocols were followed. Nurses were administering most of the IV therapies and it involved inserting peripheral and central vascular access devices. During any administration of intravenous therapy, I was observing patients closely for symptoms of any adverse reaction. This was important because according to Joan (2008), the extensive usage of IV therapy can result into complacency regarding the risks and can lead to poor practice standards, and this puts patients at a clinical harm risk, which may make nurses susceptible to a negligence claim. After medication enters into the bloodstream, the medication acts instantly and therefore the RN were taking special care to avoid inaccuracies in dose calculation and preparation. Additionally, I always ascertained the six rights of safe medication administration and identified the desired action and side effects. I discovered that if the medication had an antidote, the antidote was always availed during administration and during administration of potent medications; I ensured that vital signs were assessed prior, during and following infusion. Basically, procedures in IV therapy consisted of: initiating an IV via peripheral veins; monitoring and regulating infusion of prescribed IV solutions; monitoring patients' responses to blood and blood products; flushing peripheral intermittent devices with physiological saline or a heparin solution; in addition to administering medication via intermittent infusion through peripheral lines (Joan 2008). Site replacement in particular for catheters; the catheters were replaced after every three days in accordance with the hospital policy. At times, the RN insisted that peripheral intravenous catheter was not to be replaced unless when the patient signified some clinical indications. Regardless of the hospital policy, replacement was done during any time due to clinical indications like phlebitis, infiltration, or unexplained fever. Dressings were changed after each seven days or during any clinical indication and antiseptic solutions were used in disinfecting dressing site. Literature review Preparing and administering IV therapy needs skilled practitioners supported by extensive evidence-based practice. IV therapy also necessitates time as well as careful evaluation which consists of: evaluation of the procedure, skilled practitioner, the patient, drugs, the equipment, the setting in addition to other related elements such as infusion devices. Excluded and delayed medications are a major cause of medication incidents and this results to serious or grave effects, for example insulin, antibiotics and anticoagulants (Rodkin, 2007). During an IV therapy, the first assessment procedure should make sure that the patient is within the ward or the area whereby he/she is receiving the medication, the patient should have a patent cannula in situ, and that all the necessary equipment are present like an infusion device for the intermittent route, for example when administering a recommended antibiotic every eight hours (Ford & Phillips 2011). It is also essential to make sure that a second registered practitioner is present and that all medications are prescribed and hence administration done within the prescribed time. After identification of the necessity for IV access and selection of the suitable equipment, the practitioner should: Wash and dry hands carefully Wear both apron and gloves Clean the noticeably dirty skin using soap and clean water Clean the insertion site suing an isopropyl alcohol swab for about thirty seconds Insertion of cannula Securing of cannula with suitable hypoallergenic dressing Flushing using 0.9 percent saline and the purpose of this is to verify patency Recording cannula insertion date During the connection of an IV infusion to a cannula, the practitioner should: Wash and dry hands carefully Wear both apron and gloves Clean the access point with an isopropyl swab Utilize the aseptic technique to connect the giving set to the cannula Administration of fluid and regulate through roller clamp Securing of the giving set using suitable hypoallergenic dressing Finally, the proper date and documentation should be recorded (Lavery 2011). Lavery (2011) notes that the above procedures are an important component of an all-inclusive infection control technique during insertion, care and management of an IV cannula as well as administration of IV therapy. This is a very important technique for patients having infectious diseases and hence should not be omitted during an IV therapy. Additionally, studies show that during an administration of an IV therapy, specific control measures should be taken into consideration. Ford & Phillips (2011) argues that there are several microorganisms allied to IV medications and they include S. aureus, Pseudomonas, Klebsiella, along with C. difficile. More attention should be given to the clinical field within a patient having any of these infections, but particularly to the patients with C. difficile since this organism is a spore and therefore it can result to contamination of drip stands, IV fluid bags, giving sets in addition to the contaminating the immediate surrounding environment of the patient. Contamination of the catheter hub by microbes along with ensuing intraluminal migration is the most common entry for the microbes (Casey & Elliott 2007) Studies have shown that between 2.3 percent and 67 percent of patients receiving IV therapy develop thrombophlebitis. Infection is possibly the most common complication of CVAD use within the outpatient setting. Catheter-related infections can take place any time the device is placed. Pathogenic microbes can enter and contaminate intravascular devices through contaminating the infusate, junctions within IV tubing, and also contaminating the insertion spot (Lei 2006). Therefore, Managing IV therapy and site replacement is paramount. As a result, several interventions have been developed to lower the rate of infections such as phlebitis and this includes new catheter materials, new methods for securing the catheter in addition to heparinised catheters. For example, Centre for Disease Control recommends the catheters to be replaced after ever 72-96 hours as this limits the probability of infection. However, removal of a functional catheter and re-sitting it may expose patients to avoidable risk (Chernecky & Waller 2011). Basically, during an IV therapy, there are some skills that should not be delegated to an Licensed practical nurse (LPN) and they include: initiation of a PCA pump, administration of medication through IV push or solutions through venous central line, insertion of central line, drawing blood from a central or arterial like, administration of blood and blood products, changing of a central line dressing as well as mixing medication necessitating reconstitution (Neil 2009). Hanlon (2011) further notes that IV drug infusion therapy is not always restricted to a hospital setting. This can be attributed to the rising demands for acute hospital beds, development in treatment regiments, as well as increased level of participation for the patients in treatment decisions. This has seen IV therapies being administered within community setting and this includes skilled nursing facilities, health clinics as well as patients’ homes. In this regard, community nurses should be supported with updated information, education and clinical proficiency to guarantee best practice (Jill 2008). On the other hand, patients being provided with community IV therapy should have a reliable vascular access device, which can be placed peripherally or centrally (O'Hanlon et al 2011). Such patients can also be provided with educational courses on IV therapy. More importantly, both patients and home carers are supposed to be educated regarding all early signs and symptoms of allergic reactions and this ought to be integrated into any teaching program where patient or carers are involved in the administration of the IV therapy (Higginson 2008). According to Higginson (2011) effective site replacement is important to control the spread of infections and this can prevent several community and hospital-acquired infections. For instance, effective site replacement of catheter reduces the risk for complications associated with catheter which include phlebitis, catheter-related infections, as well as mechanical complications. Nonetheless, studies further indicate that site replacement ought to be reexamined because of the additional costs along with discomfort to the patient. Research has also shown that the prevalence of thrombophlebitis allied to peripheral intravenous catheters ranges from 5.3% to 77.5%. Several factors increase thrombophlebitis risk and ineffective site replacement is one of the factors contributing to thrombophlebitis. For example, in Sweden, elective replacement of peripheral intravenous catheters is recommended to be performed after each 12-24 hours. Some degree of scientific evidence indicates that elective replacement of peripheral intravenous catheters decreases the prevalence as well as severity of thrombophlebitis (Joan 2008). Integrating Theory and Practice According to the reviewed literature, hygiene procedures should be performed through washing hands with convectional soap and water. During nursing practice, this is performed prior and after palpating catheter insertion sites and also prior and following an insertion, replacement, access, repair or dressing of an intravascular catheter. Practitioners can act as potential portal for disease causing microorganisms and this can facilitate the spread of microorganisms between patients and the clinical setting. Likewise, an environment that is not hygienic can harbor micro-organisms and thus facilitate contamination and spread of microorganisms. Therefore, the nurses and other involved practitioners should use suitable infection control measures, which is important in fighting against disease-causing microorganisms and aids in delivering high quality and effective health service during an IV therapy (Higginson 2008) Health practitioners as well as community nurses taking part in IV therapy should be educated and be in a position to access evidence-based resources as this enhance their skills. This because during an IV therapy, the medications require calculations and expertise in dosage and therefore the practitioners should have vital skills for safe IV practice to be competent in numeracy and calculations. This will be important during practice in avoiding inaccuracies in dose calculation and preparation (Neil 2009). The assessment if the patient, procedure and equipment are crucial to ensure that the entire process is effective. In practice, this includes risk assessment of the patient, process and equipment, for instance if a high-risk therapy is suitable to be reconstituted within a clinical set up or in case a spillage takes place, there should be a spillage kit, meaning the entire assessment process should also ensure availability of all necessary equipment. The assessment of the patient includes assessing the appropriate medications for the patient’s condition, the IV method, the frequency and volume of the prescribed therapy as well as the length of the treatment as this influences the choice of cannula, site and gauge as well (Scales 2008). However, during my hospital setting experience, removal of the catheters as well as peripheral cannula used to be changed more frequently even before the elapse of 72 hours. However, according to the literature, peripheral cannula is supposed to be removed or replaced at 72 hours (Hall 2010). Additionally, peripheral cannula inserted during emergencies, where the extent of asepsis cannot be ascertained, the removal should be after 24 hours of insertion. This is because changing catheters and peripheral cannula routinely can be unnecessary and a painful intervention for patients, in addition to being expensive for the organization (Scales 2008). Recommendations The organization (hospital) should incorporate safety features for sharp injury prevention and utilize a safety cannula. The smallest gauge and shortest length of cannula should be chosen for the prescribed treatment. During an IV therapy, the involved health practitioners should always follow proper guidance and safety checklists, for instance SBAR (Rodkin, 2007). This is because the safety of the patient as well as clinical efficacy is at risk in case IV practice is not robust. All health practitioners participating in IV therapy procedures should further their learning from error, in particular during dosage calculations. All incidents and analysis should always be reported and recorded. Further studies should be carried out to verify if changing infusion cannula and catheters after every 72 hours to prevent infection is the optimum standard. This is because a study by Joan (2008) indicated that catheters can be safely left in place for more than 72 hours in no contraindications are there and that replacement of catheters only when clinically necessary illustrated that 25 percent of infusion related costs are saved. Therefore, there is need to have further research on this to verify the exact time frame for changing the infusion and the associated risks. Bibliography Casey A, & Elliott, T., 2007, Infection risks associated with needleless intravenous access devices, Nursing Standard, Vol. 22/11. Chernecky, C, & Waller, J., 2011, Comparative evaluation of five needleless intravenous connectors, Journal of Advanced Nursing, Vol. 67/7. Ford, J, & Phillips, P., 2011, An evaluation of sharp safety intravenous cannula devices, Nursing Standard, Vol. 26/15-17, 42-49. Hall, J., 2010, Clinically-indicated replacement versus routine replacement of peripheral venous catheters, Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. < http://eprints.qut.edu.au/26122/1/26122.pdf>. Higginson, R., 2008, Infection control and intravenous therapy in patients in the community, British Journal of Community Nursing, Vol. 15/7. Jill, K., 2008, Effective practice in community IV therapy, British Journal of Community Nursing, Vol. 13/7. Joan, W., 2008, Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomized controlled trial, Journal List BMJ, Vol. 337/662. Lavery, I., 2011, Intravenous practice: improving patient safety, British Journal of Nursing, Vol. 20/ 19. Lei, H., et.al, 2006, Outpatient Administration of Intravenous Therapies in Patients with HIV Infection, University of California San Francisco. Neil, M., 2009, Dr Thomas Latta: the father of intravenous infusion therapy, Journal of Infection Prevention, Vol. 10/1. < http://bji.sagepub.com/content/10/1_suppl/s3.full.pdf+html>. O'Hanlon, S., et al, 2011, Home therapy: community nurses Vs IV nurses, British Journal of Nursing, Vol. 20/ 19. O'Hanlon, S., et al, 2008, Delivering intravenous therapy in the community setting. Nursing Standard, Vol.22/31, 44-48. Rodkin, S., 2007, Purchasing for safety: standardization in intravenous equipment, British Nursing Journal, Vol. 1/17. Scales, K., 2008, Intravenous therapy: a guide to good practice: Katie Scales, British Journal of Nursing, and Vol. 17 / 19. Read More