Sponsor: Child Health Name: Paediatric IV Standards

Paediatric IV Standards

Including giving IV antibiotics

SCOPE:Applies to all Paediatric patients including adolescents who have peripheral IV access in GisborneHospital. This includes Planet Sunshine children’s ward and the emergency department where applicable.

AUTHOR:Paediatric Quality coordinator

PURPOSE:To ensure standardised clinical management of IV Lines in Paediatrics

Aims:

  • To preserve paediatric IV access
  • To maintain the IV line for as long and as safely as possible
  • To minimise trauma to the child by minimising the necessity for re-cannulation
DEFINITIONS:
Smart-site Extension: 13cm length screw on extension with attached smartsite needle free valve(leur plug), and clamp. Obtained from Alaris Medical systems. Reference No. 20039E (Stores No. 003125)

Paediatrics applies to ALL children up to their 16th birthday – (or older if admitted to Planet Sunshine)

STANDARDS:

1. All Paediatric cannula are to have a smart-site extension set attached

  • If come from Theatre or Emergency Department without a smartsite extension, paediatric nursing staff are to connectone at the earliest convenience.
  • Rationale:
  • allows easier and less traumatic access to an IV cannula
  • Allows for easier and safer IV locking of cannula when not in use

2. Smartsite extensions are to be looped back and taped to reduce tension on the line and thus

maintain patency

3. All Paediatric cannula inserted into or near a moveable joint are to be splinted to help maintain

patency.

4. IV cannula sites are to be covered with tubigrip of an appropriate size. ED staff please do not cover with a stretchy bandage. This is a waste of resource as we will remove and discard and replace with tubigrip

  • Check regularly that tubigrip is not too tight.
  • If a child comes from ED or theatre with another type of bandage, this must be changed to tubigrip
  • Rationale: Tubigrip allows easy and quick visualisation of an IV site, even when a child is asleep
  • Exceptions: The only exceptions to this are on the rare occasions when a child may ‘fiddle’ with the tubigrip. Babies cannot do this so tubigrip should be used.

5. Every time an IV line is accessed, the patency of the line mustfirst be checked by flushing with normal

Saline/Posiflush(double checked). eg for IV antibiotics or to connect IV fluids (IV Therapy Manual p57)

6. If the line has been running on TKVO (5-10mls/hr), patency of the line must also be checked using a

N/Saline flush /Posiflush

Rationale:The line may be slowly infusing into the tissues without obvious signs but the

change in pressure has been seen to cause massive infiltration (2 incidents October 2010)

7. Prior to and during flushing, the cannula insertion site must be visualised.

  • Rationale: To check that:
  • all parts of the line are connected
  • the cannula is still in situ
  • the taping is still secure
  • the site is not inflamed or infiltrated
  • during flushing, there are no signs of infiltration or leakage
  • the tubigrip is not too tight
  • the splinting is maintained and secure
  • no signs of pressure

Only then is it safe to give the IV additives or connect the IV line etc.

8. In Paediatrics, it is recommended that most IV antibiotics are given through a burette.

  • This will help maintain patency of the cannula as there tends to be less irritation on the vein

9. The recommended volume of diluent must be adhered to with the exception of a baby who may not

tolerate large volumes in a short period of time (adjust for age if necessary).

  • Follow guidelines in the Notes for Injectable drugs manual

10. The recommended time to deliver must be adhered to. (See TDH pharmacy guideline)

  • Some antibiotics once mixed are only stable for a short period of time. (eg Flucloxacillin should be given within an hour of mixing. (Antibiotics can be given at a higher rate where appropriate and depending on age as long as well diluted).

11. The burette must be well flushed (20-30 mls) to ensure all traces of the antibiotic are flushed through.

  • An insufficiently flushed line will deliver the de-stabilized antibiotic next time.
  • Caution with volumes in babies

12. IV site to be checked hourly if an infusion in progress. (IV Therapy Manual p57)

13. Cannula/smartsite extension to be given a positive pressure flush with normal saline/posiflush after disconnecting from an infusion (IV Therapy Manual p43)

  • Rationale: To lock the line to reduce chances of it blocking from backflow (Flush, clamp extension as flushing, remove syringe from smartsite luer plug. – Alaris guidelines)
  • If the line will not be accessed for more than 12 hours, the use of heparinised saline may be preferable to maintain patency.

14. Monitor IV cannula sites at least once per shift and document using the Peripheral Cannulation Insertion Record. (IV Therapy Manual p15)

  • NB.It is important to also check for pressure from the cannula, clamp or leur plug, especially in babies. Take action if signs of pressure.

15. Documentation: The Peripheral Cannulation Insertion Record (yellow form)is to be used for all

children with a peripheral cannula.All children who have an IV inserted in ED should come to the ward with this form commenced

  • Date, time, cannula gauge, and insertion sitemust be entered on insertion and if changed. (IV Therapy Manual p14)
  • Documentation of appearance of IV site using phlebitis score, and patency of IV cannula must be entered each shift (IV Therapy Manual p57)

REFERENCES

  • Tairawhiti District Health, (2007), IV Therapy Manual.
  • Cardinal Health, (2005) Alaris Products. IV Administration Sets – Smartsite Needle-Free System
  • TDH Pharmacy, (2008). Displacement values and other details of antibiotics used at GisborneHospital(Purple chart in prep room)
  • New Zealand HealthCare Pharmacist’s Association Inc. (2004). Notes on injectable drugs (5th Ed.)

Hein Stander


Clinical Director

Deb McKay


Charge Nurse Manager

Date of Approval: December 2010

Next Review Date: December 2012

Faciltator: S. Cranston Date of first approval: February 2008

Authorised By: H.Stander Date last review completed: Dec 2010Page: of 3