Back to Basics:
                        IV Site Care
               Sponsored by 3M™ Tegaderm™
                 Transparen...
Today’s Topics
1   OVERVIEW

2   DRESSING CHOICES

3   GUIDELINES AND STANDARDS

4   HOW TO APPLY & REMOVE DRESSINGS
Today’s Topics
5   TIPS FOR SOLVING PROBLEMS

6   CATHETER SECUREMENT METHODS

7   SITE ASSESSMENT & COMLICATIONS

8   DOC...
Vascular Access Devices

    200
              200 Million
              Vascular Access
              Devices Sold in
   ...
Why be Concerned?
• Loss of an IV can cause:
  – Delays in therapy
  – Increased hospital stays
• Complications can:
  – I...
Two Primary Goals of Infusion Therapy

       Improve patient outcomes


           Prevent complications
Clinician Responsibility

             Choosing
             Providing
                           Aspects
             Mon...
Today’s Topics
OVERVIEW
1

2   DRESSING CHOICES

3   GUIDELINES AND STANDARDS

4   HOW TO APPLY & REMOVE DRESSINGS
Types of Catheter Dressings

                     Transparent
                                   2



1
    Tape and Gauze
Tape and Gauze Dressings
   • Positive Features
                Absorbency
                Minimizes exposure to adhesive
...
Types of Catheter Dressings

                 Transparent
                               2




Tape and Gauze
Transparent Dressings
 Transparent Semi-
                       Transparent
  permeable
  Membrane (TSM)
                ...
Transparent Dressings
 Positive Features
  • Breathable
  • Semi-permeable barrier to external
    contaminants
  • May a...
Transparent Dressings
• Transparent film dressings:
  – Use pressure sensitive adhesives (PSA)
• PSAs are soft, allowing t...
Today’s Topics
1OVERVIEW
2DRESSING CHOICES

3   GUIDELINES AND STANDARDS

4   HOW TO APPLY & REMOVE DRESSINGS
Guidelines for PIV Dressings
      According to CDC guidelines and

CDC
      INS Standards of Practice, how
      frequen...
Guidelines for CVC Dressings
      According to CDC guidelines and

CDC
      INS Standards of Practice, when
      should...
Today’s Topics
1OVERVIEW
2DRESSING CHOICE

3GUIDELINES AND STANDARDS

4   HOW TO APPLY & REMOVE DRESSINGS
Applying Dressings
Three main steps
1. Remove the back liner
2. Press the dressing onto the site
3. Remove the frame as yo...
Application Tips
       for Transparent Adhesive Dressings


             APPLICATION TIP                          True or...
Application Tips
       for Transparent Adhesive Dressings

              APPLICATION TIP                         True or ...
Removing Dressings
Dressing Removal Techniques

   Low and Slow




             Stretch Release
Today’s Topics
5   TIPS FOR SOLVING PROBLEMS

6   CATHETER SECUREMENT METHODS

7   SITE ASSESSMENT & COMPLICATIONS

8   DO...
Tips for Solving Problems
MOST COMMON CAUSES of ADHESION PROBLEMS



   1 Failure to apply the dressing with
       pressu...
Failure to Apply Pressure
 Review:
    Application


Can cause:
    Lifting
    Rolling
    Falling off
              ...
Failure to Allow Preps to Dry
Review:
    Skin Preparation


 Make sure the skin is clean and dry
 Allow preps to dry t...
Skin Injuries
Skin Injuries: Skin Stripping
Skin Stripping appears:
  – As a reddened area…or…
  – As shiny skin

Occurs more often:
  •...
Preventing Skin Stripping


           Use an alcohol-free
           film type skin
           protectant
S.P.A.R.E.
•   Select the right product
•   Prepare the skin and position the body
•   Apply using appropriate technique
•...
Today’s Topics
TIPS FOR SOLVING PROBLEMS
5

6   CATHETER SECUREMENT METHODS

7   SITE ASSESSMENT & COMPLICATIONS

8   DOC...
Why Attend to Securement?
 Visualizing the Site

   Minimizing Movement
      Preventing Contamination

            Avoidi...
Types of Catheter Securement
•   Tape
•   Transparent adhesive dressings
•   Island dressings
•   Anchor securement device...
Types of Catheter Securement
                    Modified
                  Transparent
                   Adhesive
      ...
Types of Catheter Securement
   Modified
    Tape                                           Shield




                   ...
U Taping Technique
Chevron Taping Technique
Modified Dressings

              What are the
             challenges you
               see here?



                  ?
Modified Dressings
Modified Dressings
with borders & notch:
• Protection for the
  insertion site
• Better stabilization
•...
Tips for Challenging Sites
• Clip Hair
• Turn patient’s
  head away
• Extend the
  neck fully
• Use additional
           ...
Tips for Challenging Sites
 Provide additional
  securement or taping
 Stabilize catheter
  extensions
 Position tape s...
Today’s Topics
5TIPS FOR SOLVING PROBLEMS
6CATHETER SECUREMENT METHODS

7   SITE ASSESSMENT & COMPLICATIONS

8   DOCUMEN...
IV Site Assessment
• FREQUENCY
• INFUSATE                         Look for signs
                                    or s...
Phlebitis
What is it?
 Inflammation in
  the walls of the
  vein
 INS scale of 0 - 4
Image Courtesy and © Becton, Dickin...
Phlebitis: INS Scale
Signs and Symptoms – INS Scale of 0 - 4
  – Redness - Erythema (1) (2) (3) (4)
  – Pain or tenderness...
Phlebitis
             Cause                  Mechanical   Chemical   Bacterial

Failure to scrub hub with alcohol
Infusio...
Phlebitis
             Cause                  Mech   Chem   Bact
Failure to scrub hub with alcohol
Infusion rate too rapid...
Phlebitis
              Cause                 Mech   Chem   Bact
Failure to scrub hub with alcohol                  X
Infu...
Infiltration
What is it?
 Inadvertent
  administration of
  an IV solution into
  surrounding
  tissues
                 ...
Infiltration
                                    Frequent complication
                                    Often goes un...
Infiltration
Causes include:
  – Improper selection of catheter or site
  – Catheter gauge too large for the vein
  – Trau...
Extravasation
What is it?
 Inadvertent
  administration of a
  vesicant agent
 MUST be identified
  quickly             ...
Extravasation
Signs and symptoms include:
  – Severe pain or burning during infusion
  – Blotchy redness surrounding the i...
Extravasation
Causes:
  – Same as for infiltration…
  BUT occur when….
  – A peripheral route is selected
  – When a centr...
Catheter-Related Infection
 Identification is
  crucial
 Early detection of
 local infections can
 prevent systemic
 inf...
Catheter-Related Infection
Signs and Symptoms include:
  – Erythema or redness – warm to the touch
  – Tenderness
  – Swel...
Check Your Understanding
5. Which signs and symptoms are true of
   infiltration? Of catheter-related infection? Of
   phl...
Today’s Topics
5TIPS FOR SOLVING PROBLEMS
6CATHETER SECUREMENT METHODS

7SITE ASSESSMENT & COMPLICATIONS

8   DOCUMENTA...
Documentation-
            for insertion of VAD
In the medical record include:
   – Size length, and type of catheter
   –...
Dressing Label Documentation
          Dressing Label Documentation
         New PIV           CVC Dressing Change
Date / ...
Documentation
For Complications, document the:
  • Occurrence and severity of the complication
  • Size of the catheter an...
Two Primary Goals of Infusion Therapy

             Together, well-informed
             practitioners and correctly
     ...
For more information or to view other
 educational programs sponsored by
  3M™ Tegaderm™ Transparent Film
           Dress...
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3M™ Tegaderm™ Dressings IV Site Care

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Get back to the basics with this IV Site Care presentation from 3M™ Tegaderm™ Dressings. Complete with examples, recommendations and best practises, learn more from 3M Skin & Wound Care at http://go.3M.com/Tegaderm4Dressings

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3M™ Tegaderm™ Dressings IV Site Care

  1. 1. Back to Basics: IV Site Care Sponsored by 3M™ Tegaderm™ Transparent Film Dressings © 3M 2007. All Rights Reserved.
  2. 2. Today’s Topics 1 OVERVIEW 2 DRESSING CHOICES 3 GUIDELINES AND STANDARDS 4 HOW TO APPLY & REMOVE DRESSINGS
  3. 3. Today’s Topics 5 TIPS FOR SOLVING PROBLEMS 6 CATHETER SECUREMENT METHODS 7 SITE ASSESSMENT & COMLICATIONS 8 DOCUMENTATION
  4. 4. Vascular Access Devices 200 200 Million Vascular Access Devices Sold in the U.S. 100 Millions Frost and Sullivan, 2005
  5. 5. Why be Concerned? • Loss of an IV can cause: – Delays in therapy – Increased hospital stays • Complications can: – Increase morbidity and mortality – Delay discharge – Increase health care costs
  6. 6. Two Primary Goals of Infusion Therapy Improve patient outcomes Prevent complications
  7. 7. Clinician Responsibility Choosing Providing Aspects Monitoring of Infusion Assessing Therapy Documenting Do no harm
  8. 8. Today’s Topics OVERVIEW 1 2 DRESSING CHOICES 3 GUIDELINES AND STANDARDS 4 HOW TO APPLY & REMOVE DRESSINGS
  9. 9. Types of Catheter Dressings Transparent 2 1 Tape and Gauze
  10. 10. Tape and Gauze Dressings • Positive Features Absorbency Minimizes exposure to adhesive  Limitations • Poor adhesion • Poor barrier to bacteria • No barrier to fluids • Must be removed to assess the site and changed every 48 hours (CDC & INS) • Bulky and uncomfortable for patients • Provide little stability for catheter securement
  11. 11. Types of Catheter Dressings Transparent 2 Tape and Gauze
  12. 12. Transparent Dressings  Transparent Semi- Transparent permeable Membrane (TSM) 2  Transparent Adhesive Dressings (TAD)  Transparent Film Dressings
  13. 13. Transparent Dressings  Positive Features • Breathable • Semi-permeable barrier to external contaminants • May also provide a barrier to bacteria and viruses • Help secure and stabilize the catheter  Limitations Not absorbent May not be appropriate for sites with: Excessive bleeding Skin previously compromised
  14. 14. Transparent Dressings • Transparent film dressings: – Use pressure sensitive adhesives (PSA) • PSAs are soft, allowing them to: • Conform to the irregular surface of the skin • Stick well to the contours of the body.
  15. 15. Today’s Topics 1OVERVIEW 2DRESSING CHOICES 3 GUIDELINES AND STANDARDS 4 HOW TO APPLY & REMOVE DRESSINGS
  16. 16. Guidelines for PIV Dressings According to CDC guidelines and CDC INS Standards of Practice, how frequently should a transparent adhesive dressing applied to a peripheral IV be changed? INS A. Every 2 hours B. Every 10 days C. Every 72-96 hrs or w/site rotation D. Once per month
  17. 17. Guidelines for CVC Dressings According to CDC guidelines and CDC INS Standards of Practice, when should CVC dressings be changed? A. Every 48 hours for gauze, tape and gauze, or island dressings INS B. When the dressing is compromised in any way C. Every 7 days for transparent dressings D. With site rotation
  18. 18. Today’s Topics 1OVERVIEW 2DRESSING CHOICE 3GUIDELINES AND STANDARDS 4 HOW TO APPLY & REMOVE DRESSINGS
  19. 19. Applying Dressings Three main steps 1. Remove the back liner 2. Press the dressing onto the site 3. Remove the frame as you smooth the edges Remember to • Use firm pressure • Make sure extensions & IV tubing are secured
  20. 20. Application Tips for Transparent Adhesive Dressings APPLICATION TIP True or False? 1. Make sure the skin is free of soaps, detergents, and lotions. TRUE 2. Very gently press the dressing into place. FALSE
  21. 21. Application Tips for Transparent Adhesive Dressings APPLICATION TIP True or False? 3. STRETCH the tape or dressing during application. FALSE 4. Place a small strip of sterile tape over the hub without obscuring the site for added catheter TRUE stability.
  22. 22. Removing Dressings
  23. 23. Dressing Removal Techniques Low and Slow Stretch Release
  24. 24. Today’s Topics 5 TIPS FOR SOLVING PROBLEMS 6 CATHETER SECUREMENT METHODS 7 SITE ASSESSMENT & COMPLICATIONS 8 DOCUMENTATION
  25. 25. Tips for Solving Problems MOST COMMON CAUSES of ADHESION PROBLEMS 1 Failure to apply the dressing with pressure to the edges Failure to allow prepping 2 agents to dry thoroughly
  26. 26. Failure to Apply Pressure Review:  Application Can cause:  Lifting  Rolling  Falling off Rolling – Edge Lift
  27. 27. Failure to Allow Preps to Dry Review:  Skin Preparation  Make sure the skin is clean and dry  Allow preps to dry thoroughly  Clip (don’t shave) body hair as needed
  28. 28. Skin Injuries
  29. 29. Skin Injuries: Skin Stripping Skin Stripping appears: – As a reddened area…or… – As shiny skin Occurs more often: • In patients with fragile skin • Where an aggressive adhesive was used
  30. 30. Preventing Skin Stripping Use an alcohol-free film type skin protectant
  31. 31. S.P.A.R.E. • Select the right product • Prepare the skin and position the body • Apply using appropriate technique • Remove using appropriate technique • Evaluate skin site, Eliminate causative factors, Educate others, Elect to report skin problems to manufacturer
  32. 32. Today’s Topics TIPS FOR SOLVING PROBLEMS 5 6 CATHETER SECUREMENT METHODS 7 SITE ASSESSMENT & COMPLICATIONS 8 DOCUMENTATION
  33. 33. Why Attend to Securement? Visualizing the Site Minimizing Movement Preventing Contamination Avoiding Removal Problems Later
  34. 34. Types of Catheter Securement • Tape • Transparent adhesive dressings • Island dressings • Anchor securement devices • Sutures or staples • Adhesive skin closures (e.g., 3M™ Steri-Strip™ Skin Closures) Infusion Nursing Standards of Practice -2006
  35. 35. Types of Catheter Securement Modified Transparent Adhesive Dressings ConMed™ Tri-State Centurion® Veni-Gard® SorbaView® 2000 Window Dressing 3M™ Tegaderm™ Dressing
  36. 36. Types of Catheter Securement Modified Tape Shield Anchor Tri-State Centurion® WingGuard® Tri-State Centurion® I.V. House Ultra I.V. House HubGuard® Dressing™ IV Site Protector ™
  37. 37. U Taping Technique
  38. 38. Chevron Taping Technique
  39. 39. Modified Dressings What are the challenges you see here? ?
  40. 40. Modified Dressings Modified Dressings with borders & notch: • Protection for the insertion site • Better stabilization • Reduced mechanical stress NOTE: Modified dressings DO NOT replace the need for sutures in CVCs
  41. 41. Tips for Challenging Sites • Clip Hair • Turn patient’s head away • Extend the neck fully • Use additional Subclavian and Internal Jugular taping non- tunneled Central Venous techniques Catheter Sites
  42. 42. Tips for Challenging Sites  Provide additional securement or taping  Stabilize catheter extensions  Position tape so ports can be accessed Multi-lumen Catheters
  43. 43. Today’s Topics 5TIPS FOR SOLVING PROBLEMS 6CATHETER SECUREMENT METHODS 7 SITE ASSESSMENT & COMPLICATIONS 8 DOCUMENTATION
  44. 44. IV Site Assessment • FREQUENCY • INFUSATE  Look for signs or symptoms of • ASSESSMENT complications – Insertion site  Identify problems – Patient’s condition early – Patient’s need for therapy
  45. 45. Phlebitis What is it?  Inflammation in the walls of the vein  INS scale of 0 - 4 Image Courtesy and © Becton, Dickinson and Company
  46. 46. Phlebitis: INS Scale Signs and Symptoms – INS Scale of 0 - 4 – Redness - Erythema (1) (2) (3) (4) – Pain or tenderness along the vein (2) (3) (4) – Edema (2) (3) (4) – Streak formation (3) (4) – Palpable corded vein (3-beg) (4) – Purulent drainage at insertion site (4)
  47. 47. Phlebitis Cause Mechanical Chemical Bacterial Failure to scrub hub with alcohol Infusion rate too rapid for vein Solution too acidic or alkaline Improper skin preparation Traumatic insertion X Medications into a small vein Inadequate stabilization X
  48. 48. Phlebitis Cause Mech Chem Bact Failure to scrub hub with alcohol Infusion rate too rapid for vein X Solution too acidic or alkaline X Improper skin preparation Traumatic insertion Medications into a small vein X Inadequate stabilization
  49. 49. Phlebitis Cause Mech Chem Bact Failure to scrub hub with alcohol X Infusion rate too rapid for vein Solution too acidic or alkaline Improper skin preparation X Traumatic insertion Medications into a small vein Inadequate stabilization
  50. 50. Infiltration What is it?  Inadvertent administration of an IV solution into surrounding tissues Image Courtesy of N. Costa
  51. 51. Infiltration  Frequent complication  Often goes undetected  Signs  Swelling / Edema  Taut/stretched skin  Cool to the touch  Tenderness at the site  Infusion – sluggish or stopped Image Courtesy of N. Costa
  52. 52. Infiltration Causes include: – Improper selection of catheter or site – Catheter gauge too large for the vein – Traumatic insertion – Inadequate securement – Catheter inserted over a joint Source: INS S59-60
  53. 53. Extravasation What is it?  Inadvertent administration of a vesicant agent  MUST be identified quickly Image Courtesy and © Becton, Dickinson and Company
  54. 54. Extravasation Signs and symptoms include: – Severe pain or burning during infusion – Blotchy redness surrounding the insertion site – Edema at the insertion site – A slowed or stopped infusion rate
  55. 55. Extravasation Causes: – Same as for infiltration… BUT occur when…. – A peripheral route is selected – When a central route SHOULD be used Vesicants (irritating agents) – Best administered through CVC
  56. 56. Catheter-Related Infection  Identification is crucial  Early detection of local infections can prevent systemic infections PICC Infection Image Courtesy of N. Costa
  57. 57. Catheter-Related Infection Signs and Symptoms include: – Erythema or redness – warm to the touch – Tenderness – Swelling – With or without drainage – Changes in heart rate, BP – Elevated temps
  58. 58. Check Your Understanding 5. Which signs and symptoms are true of infiltration? Of catheter-related infection? Of phlebitis? Signs and Symptoms Infiltr. CRI Phlebitis Fever X X Taut or stretched skin X Redness at insertion site X X X Tenderness at insertion site X X X Coolness of the skin X Drainage X X Sluggish infusion X
  59. 59. Today’s Topics 5TIPS FOR SOLVING PROBLEMS 6CATHETER SECUREMENT METHODS 7SITE ASSESSMENT & COMPLICATIONS 8 DOCUMENTATION
  60. 60. Documentation- for insertion of VAD In the medical record include: – Size length, and type of catheter – Name of person who inserted it – Date, time, and insertion site – Complications, patient response, any nursing interventions – Patient teaching and evidence of patient understanding – Number of venipuncture attempts – Medications used
  61. 61. Dressing Label Documentation Dressing Label Documentation New PIV CVC Dressing Change Date / time of insertion Date / time of change Device Gauge / size and length Your Initials Your Initials *Dressing change due date * Always review and follow your facility’s policy and procedure for dressing change documentation.
  62. 62. Documentation For Complications, document the: • Occurrence and severity of the complication • Size of the catheter and location of insertion • Estimated amount of drainage at the site or the amount of fluid that was infused subcutaneously or infiltrated • Actions taken to treat the complication • Communication with physicians
  63. 63. Two Primary Goals of Infusion Therapy Together, well-informed practitioners and correctly performed IV site care form a strong line of defense to improve patient outcomes and prevent complications.
  64. 64. For more information or to view other educational programs sponsored by 3M™ Tegaderm™ Transparent Film Dressings, visit: www.3M.com/tegaderm Or www.3M.com/tegadermchg
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