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Wed, 05/14/2008 - 16:21
#1
Elizabeth.Raucci
Coverage of a PIV site
Can anyone provide EBP support for use (or non-use) of coban, Kerlix or stockinette over a PIV site on an agitate patient to prevent dislodging of the IV?  This info will become part of our hospital's "restraint policy"  Thank you......I have been unsuccessful in my attempt to find clear cut evidence pro or con. 
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Thu, 05/15/2008 - 13:14
Angela Lee
In extreme cases such as you
In extreme cases such as you mention it may be necessary to protect the PIV from the patient.  I would choose the easiest "cover-up" to remove.  Generally, this practice is not standard of care and very discouraged.  I believe the INS standards of care speak to this.  The more difficult or inconvenient it is to remove the less likely it is that proper site assessment will be done which increases the possiblility of extreme and damaging complications.  I would much prefer a stockinette over any wrap around material.  It's easier to pull away from the site for assessment and less likely to constrict circulation.  Regular site assessment must be emphasized to the staff because this population (agitated, combative, disoriented) can also dislodge their catheters more easily.  I do not think IV protection is considered restraint.
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Thu, 05/15/2008 - 18:47
lynncrni
I agree - this is not a

I agree - this is not a restraint in any sense of the definition. Any form of dressing wrapped around the extremity is associated with problems, although I can not quote you and recent studies. This is one of those times when you will need to rely on expert opinion as your evidence, although this is a low form of evidence it is still a form of evidence. As Angela said, covering the entire site is a huge problem. The patient can not get to it but that also means that nurses will not be assessing it either. On rare occasions, I have used Kling or Kerlix loosely wrapped around a site of a confused geriatric patient. This was placed from the dressing down to include the tubing loop, but not to cover from the insertion site upward. Stockinette may work best for some but it could also give confused patients more "holes" to play with or pull at. This is only necessary when the risk of the patient pulling out the IV outweighs the risk of the additional dressing and is a case-by-case decision. Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN,  CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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