1. Section Editor(s): Huber, Deb MSN, ARNP, CGRN

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If you have never taken the opportunity to visit the Discussion Forum on the SGNA Web site, you have not yet realized the helpful information that is being discussed in work situations similar to yours. Many different topics are available with postings almost daily. When you do not have the opportunity to go to meetings and network with others, it is sometimes hard to come up with answers to workplace questions or problems. With the Discussion Forum tool, however, you can simply post your question on the Discussion Forum and your peers will respond with suggestions or tell how they approach your issue in their institution.


One recent posting on the Discussion Forum about intravenous (IV) fluids caught my eye. Do we need to document the amount of IV fluid given? Many who responded addressed this question and documentation of IV sites. There seemed to be a general consensus from the respondents that these variables were documented.


When we initially look at documentation issues, what are we going to address?


Usually we are looking at the following issues:


* The IV site


* Who started the IV drip?


* Type and size of the needle


* Type of IV fluid



But are there other issues to document? Let's start with the IV site. Is it a working IV site? Do the fluids infuse without difficulty? Is it an easily accessible area? Did it take several attempts to obtain IV access and is that documented? Is there swelling, bruising, or redness at the site? Is the site too small to accommodate the viscosity or rate of fluids we wish to instill? What type of catheter was used? In most records I have seen, these types of questions are documented when the catheter is initially placed in the admissions area.


When the patient is being discharged, the condition of the site is often noted and whether the catheter is intact upon removal. Often there is a nursing note if there was a problem with the IV catheter during the procedure and it had to be restarted. Was it accidentally pulled out, did swelling occur at the site, was it kinked?


One of the most common phone calls I have noticed after a procedure is people calling back after the procedure about their IV site. Many complain of tenderness. There may be swelling or discomfort. Many times a patient or a family member just needs reassurance that this will resolve in time, but there are times it can be more serious.


Another concern is the IV solution and amount given. Several solutions are available and most units will probably have one or two they use most commonly. Often normal saline or a solution with a little dextrose serves as base. Most of us will hang an IV bag. Do you typically use 250-, 500-, or 1,000-mL bags? Does amount matter? I am sure this has happened to most of us in our nursing careers: You start an IV drip that is a little positional and set the drip rate. The patient changes position, and when you look again, the whole bag has gone in and blood is backing up into the IV tubing. If you have a patient with congestive heart failure or renal problems and fluid restrictions, can the extra fluid be a problem?


Another thing to look at in relation to an IV site is piggybacking another drug into your primary IV line. Some people may elect to do a second site and that should also be documented; but, if there is an adequate IV line going in, many times we give an additional drug through that primary line. Many endoscopists order IV antibiotic prophylaxis for procedures. Again, I think it may be important to document the drug, the solution it is in, and the length of the infusion time.


Because of the infusions (and especially with ancillary drugs), it is important to look for signs of reactions such as rashes, headaches, and vein irritation (i.e., redness extending up the arm from the IV site). Because many endoscopy areas utilize conscious sedation with an IV site to administer these drugs, it may be very important to look at the site if the patient is complaining of inadequate lack of sedation.


IV lines are started everyday in the clinical setting and fluids run in with very few problems generally; however, this is probably one of those areas when it is better to be safe than sorry. It takes very little time and effort to document. Thorough documentation can be a real lifesaver in many situations. If it is incorporated into the standardized paperwork of institutions (whether inpatient or outpatient), there should be no question as to who did what. These are just a few thoughts, but most of the people who gave input into this topic on the Discussion Forum agreed that documentation was important. Sometimes when we do things, we assume everyone else does it that way; but, the support of others' approach can be useful to develop protocols for institutions that have not done it the "usual" way.