Checking IV sites can be made easier
At Children’s Hospital Medical Center in Cincinnati, it is a policy to check intravenous (IV) sites every hour, says Lynn Daum, RN, BSN, an ED nurse at the facility. "This is because in a pediatric institution, kids aren’t as gentle with their IVs as adults may be," she says. "This can cause the IV catheter to become dislodged."
If this occurred, not only would an IV have to be restarted, but there also can be adverse reactions to the medications or IV fluid additives if they infiltrate into the tissues, warns Daum. "Some of these reactions can be as simple as minor swelling or as severe as sloughing of the skin, pain, severe swelling, or in rare cases, the loss of the extremity," she says.
By checking every hour with active patients, these adverse reactions can be avoided, Daum explains. To ensure this is done, she routinely clocks in one hour’s worth of fluid into the pump even though she could put in up to four hours. "That way someone — whether it is me or someone else — is forced to go into the room and check," she says. Daum also puts the patient’s identification bracelet on the same extremity as the IV. "That way it is easy to check site, fluids, and ID at the same time," she says.
Verify identification first
She stresses to always check the ID prior to doing anything for a patient. If the ID bracelet is on the same arm as the IV, it will be a reminder and easier to check, before hanging IV fluids or medications, she says. "Another reason is because toddlers really hate those bracelets, and they cry and attempt to remove them," she says. "If they are on the same arm as the IV, they have only one extremity "bothered" and seem to leave the bracelets alone."
[Editor’s note: For more information, contact Lynn Daum, RN, BSN, Emergency Department, Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229. Telephone: (513) 636-4718. Fax: (513) 636-8724. E-mail: Lynn.Daum@chmcc.org.]