Peripheral Intermittent Infusion Device (PRN Lock)

1. Peripheral Intermittent Infusion Device(PRN Lock) Maggie VeVone Erin Reed Kelly Lupo Allison Peck

2. Peripheral Intermittent Infusion Device • Otherwise known as prn lock or PIID • UUH @ CGH purpose: To provide a means of venous access without continuous intravenous infusion • When an actual or potential need for IV medications exists a PIID may be ordered • A previous IV infusion can be converted to a PIID with a physicians order

3. Evidence Based Practice • Clients who received intermittent IV therapy via a saline lock were more independent with regard to ability to perform self care ADLs than those who received continuous IV therapy

4. Converting • Identify patient and order • Wash hands • Gloves • Identify existing IV site for phlebitis, infiltration, redness, or soreness • Assess need for new site (per CGH- call IV team) • Clamp infusion, disconnect tubing and discard per policy • Tape PIID on arm to minimize risk of losing site • If dressing change occurs date when IV was initiated (not date of change!) • Close side clamp

5. Flushing Site • When flushing with saline if resistance is felt 1.) Aspirate 2.) Pull back on catheter hub 3.) Re-attempt saline flush - If all above interventions were unsuccessful remove catheter and call for restart

6. PIID Care • Wash your hands thoroughly! • Make sure site is dated, timed, and initialed • Assess site for any phlebitis or infiltration • “Scrub the hub” for 15 seconds, dry 15 seconds • Flush site with 3 ml of normal saline after each med administration and at least once every 8 hours

7. Normal Saline VS. Heparin The American Journal of Health- System Pharmacy states the following: • 0.9% sodium chloride is the preferred method over heparin flushes • 0.9% sodium chloride is as effective and is safer due to decreased potential for adverse effects • 0.9% sodium chloride avoids drug incompatibilities • 0.9% sodium chloride is a cost-effective alternative

8. Site Changes • CGH policy recommends site changes every 96 hours • The CDC recommends: 1.) There is no need to replace IV sites more frequently than every 72-96 hours 2.) Changing sites prevents phlebitis and catheter related infections 3.) These risks increase >72 hours 4.) 72-96 hour intervals reduce risk for infection as well as patient discomfort

9. Evidence Based Practice • The British Journal of Nursing states: 1.) IV route is a portal of entry for infection 2.) Health care workers should see every patient as susceptible to infection 3.) Follow standard infection control regarding IV care 4.) Scrub the hub for at least 15 seconds and let dry 30 seconds 5.) Strict asepsis regarding any hubs, ports, or infusion lines is crucial to decrease risk of infection

10. Chain of Infection

11. Complications • http://www.medcomrn.com/js/movie/qt.php?movie=m266c_full_300k&title=

12. Remember… Always follow aseptic technique and follow your agencies policy and procedures to prevent infection. Don’t be that nurse!