{"id":3702,"date":"2015-06-22T23:06:49","date_gmt":"2015-06-22T23:06:49","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=3702"},"modified":"2021-06-09T16:50:17","modified_gmt":"2021-06-09T16:50:17","slug":"8-6-iv-complications","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-6-iv-complications\/","title":{"raw":"8.6 Converting an IV Infusion to a Saline Lock and Removal of a Peripheral IV","rendered":"8.6 Converting an IV Infusion to a Saline Lock and Removal of a Peripheral IV"},"content":{"raw":"A peripheral IV may be converted to a saline lock when a prescribed continuous IV therapy is switched to intermittent IV or a saline lock for future use. A physician's order is required to stop a continuous infusion. Checklist 71 describes how to convert an infusion to a saline lock.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 71: Converting an IV Infusion to a Saline Lock<\/caption>\r\n
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Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
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Steps<\/h4>\r\n<\/td>\r\n

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\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Verify physician orders to convert IV infusion to a saline lock.<\/td>\r\nEnsures correct order is being implemented.<\/td>\r\n<\/tr>\r\n
2. Perform hand hygiene; collect supplies.<\/td>\r\nThis prevents the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"153\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
3. Identify yourself; identify the patient using two identifiers and comparing the MAR to the patient's wristband; explain the procedure to the patient.<\/td>\r\nProper identification prevents errors. Explaining the procedure educates the patient and allows time for patient to ask questions.\r\n\r\n[caption id=\"attachment_6143\" align=\"aligncenter\" width=\"158\"]\"Compare<\/a> Compare MAR with patient wristband[\/caption]<\/td>\r\n<\/tr>\r\n
4. Perform hand hygiene.<\/td>\r\nThis step prevents the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n
5. Stop IV infusion with clamp or turn off EID. Apply clean gloves.<\/td>\r\nThis prevents fluid from escaping from tubing when disconnecting tubing from positive pressure cap (hub).<\/td>\r\n<\/tr>\r\n
6. Scrub the connection area between the hub and IV tubing for 15 seconds and let dry for 30 seconds.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6178\" align=\"aligncenter\" width=\"166\"]\"Scrub<\/a> Scrub the connection between the IV tubing and positive pressure cap[\/caption]<\/td>\r\n<\/tr>\r\n
7. Disconnect primary tubing from the extension tubing; ensure the positive pressure cap remains on the extension tubing. Place a sterile cap on end of IV tubing if tubing will be reconnected for later infusion.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6183\" align=\"aligncenter\" width=\"186\"]\"Disconnect<\/a> Disconnect IV tubing from saline lock[\/caption]<\/td>\r\n<\/tr>\r\n
8. Scrub the hub for 15 seconds and let dry for 30 seconds.<\/td>\r\nAseptic technique is required for all IV procedures. All access ports must be disinfected to decrease the bacterial load prior to use.\r\n\r\n[caption id=\"attachment_6157\" align=\"aligncenter\" width=\"202\"]\"Cleaning<\/a> Clean positive pressure cap (Max Plus) with alcohol swab[\/caption]<\/td>\r\n<\/tr>\r\n
9. Attach 10 ml syringe prefilled with 0.9% normal saline and flush saline lock to clear the positive pressure cap. Do not bottom out syringe.<\/td>\r\nTurbulent stop-start flush ensures full flushing of the catheter.\r\n\r\nBottoming out the saline syringe with the plunger can cause reflux of fluid back into the catheter.\r\n\r\nIf resistance is felt, do not force flush. Assess IV site for pain, redness, or swelling.\r\n\r\n[caption id=\"attachment_6187\" align=\"aligncenter\" width=\"160\"]\"Flushing<\/a> Flush saline lock[\/caption]<\/td>\r\n<\/tr>\r\n
10. Remove syringe and discard.<\/td>\r\nProper disposal of equipment prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_6185\" align=\"aligncenter\" width=\"188\"]\"Discard<\/a> Discard syringe[\/caption]<\/td>\r\n<\/tr>\r\n
11. Clamp extension tubing.<\/td>\r\nClamping the extension tubing as close to the IV site as possible prevents negative fluid displacement and accidental aspiration of blood at the catheter tip.\r\n\r\n[caption id=\"attachment_6189\" align=\"aligncenter\" width=\"161\"]\"Close<\/a> Close clamp on saline lock[\/caption]\r\n\r\n[caption id=\"attachment_6161\" align=\"aligncenter\" width=\"164\"]\"Saline<\/a> Saline lock[\/caption]<\/td>\r\n<\/tr>\r\n
12. Wipe top of positive pressure cap with alcohol swab to remove fluid residue.<\/td>\r\nRemoval of excess fluid prevents bacterial growth on the hub.<\/td>\r\n<\/tr>\r\n
13. Document procedure as per agency policy.<\/td>\r\nDocument date, time, and IV site assessment.<\/td>\r\n<\/tr>\r\n
Data source: Perry et al., 2014; Vancouver Coastal Health, 2008<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

<\/a>Video 8.4<\/h3>\r\n
Watch a video\u00a0Converting an IV to a saline lock \u2013 Extension Present<\/em><\/a> by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n
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<\/a>Video 8.5<\/h3>\r\n
Watch a video Converting an IV to a saline lock \u2013 No Extension Present<\/em><\/a> by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<\/div>\r\nA peripheral IV (saline lock) may be discontinued if ordered by a physician or nurse practitioner; if the patient is discharged from a health care facility; if signs of phlebitis, infiltration, or extravasation occur; or if the saline lock is no longer required for fluids or medication (Fulcher & Fraser, 2007). Peripheral IV\u2019s should be removed promptly when no longer needed to avoid a catheter-related bloodstream infection (CR-BSI), as well as unnecessary pain and trauma (Infusion Nurses Society, 2012). In general, saline locks are changed every 72 hours. If a patient has a peripheral IV in an area of flexion, the IV site should be replaced within 24 hours, or when the patient is stable. Other research shows that peripheral IV cannulas should not be routinely changed but replaced based on whether the site is functioning, the saline lock is required, the insertion site is patent, and\/or the insertion site is a source of infection (CDC 2011; Infusion Nurses Society, 2011).\r\n\r\nAt times, a physician may order IV fluids to be discontinued but request to have the IV converted to saline lock. Be sure to assess the order for discontinuing an IV. Before removing an IV, consider the following:\r\n