HHC Health & Home Care Clinical Policy And

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HHC HEALTH & HOME CARE Antepartum/Postpartum/Maternal/Newborn: References REFERENCES American Diabetes Association. 2001. Clinical practice recommendations A woman’s guide to breastfeeding. 2004. American Academy of Pediatrics. Available from http://www.aap.org/family/brstguid.htm. Behrman, R. et al. 2000. Nelson texbook of pediatrics. 16 th ed. Philadelphia: W. B. Saunders Company. Cradle cap. Excerpted from Caring for baby and young child: Birth to age 5. 2002. American Academy of Pediatrics. Available from http://www.medem.com/medlbe Cunningham, G. et al. 2000. Williams obstetrics. 21 st ed. Norwalk, CT: Appleton & Lange. Hockelman, R. 2001. Primary pediatric care. 4 th ed. St. Louis: Mosby Year Book, Inc. Ladewig, N. et al. 1998. Clinical handbook: Maternalnewborn nursing care—The nurse, the family, the community. 4 th ed. Addison-Wesley Publishing. Lawrence, R. A. 1999. Breastfeeding: A guide for the medical profession. 5 th ed. St. Louis: The C. V. Mosby Company. Lowdermilk, D. L., S. E. Perry, and I. M. Bobak. 1999. Maternity nursing. 5 th ed. St. Louis: The C. V. Mosby Company. Littleton, L. et al. 2001. Maternal, neonatal and women’s health nursing. Delmar Publishers. Nettina, Sandra M., and L. S. Brunner. 2000. The Lippincott manual of nursing practice. 7 th ed. Philadelphia: J. B. Lippincott Company. Olds, Sally B., Marcia L. London, and Patricia A. Wieland-Ladewig. 2000. Maternal newborn nursing: A family and community-based approach. 6 th ed. Prentice Hall Health. Rice, Robyn. 1998. Handbook of pediatric and postpartum homecare procedures. p.389. St. Louis: The C. V. Mosby Company. Sears, M. et al. 2000. The breastfeeding book: Everything you need to know about nursing your child from birth through weaning. Little Brown and Company. Whaley, R., and Donna L. Wong. 1999. Nursing care of infants and children. 6 th ed. St. Louis: The C. V. Mosby Company. Wong, Donna L., and Carolyn S. Hess. 2000. Wong and Whaley’s clinical manual of pediatric nursing. 5 th ed. St. Louis: The C. V. Mosby Company. 246
HHC HEALTH & HOME CARE Section 11-1 Pediatrics: Infusion __RN PURPOSE: To administer intravenous fluids or intravenous medications to a child. CONSIDERATIONS: 1. Whenever possible, use a route other than intravenous because of the risk involved with children. 2. The site must be chosen carefully and special care taken to preserve the vein because a child's veins are so small. 3. The hands and forearms are the best sites for intravenous therapy. Scalp, umbilical, foot and leg veins are not recommended because of high risk of phlebitis and/or limitation of activity. No cutdown should be done at home. 4. The caregivers of the child must be carefully screened and educated in the care of the child with intravenous therapy. 5. A child is less tolerant of fluid and medication overdoses because of his/her small size. 6. Since a child's metabolism is three times faster than an adult's, accurate records are necessary because complications develop quickly. Monitor intake and output. Assess weight, general condition, and laboratory studies frequently. 7. For older children, showing the equipment and practicing on a stuffed animal is helpful. 8. Restraining an infant at home for intravenous therapy is not recommended (if absolutely needed, a physician’s order is required). Infants, toddlers, preschoolers and very active children may need a protective device to keep child from dislodging the IV catheter. The type and size of the device should be appropriate to the type and placement of the IV catheter, the child’s developmental level and overall condition. 9. Pediatric infusion sets, mini-drips, and pumps should be used. Infusion control devices are recommended for children under the age of 10 years. Fluid to be infused should be ordered in milliliters per hour by the physician. 10. Only an experienced intravenous nurse should attempt to start an intravenous on a child. 11. If possible, the nurse should prepare the parent(s)/caregiver(s) and the child for intravenous therapy: teaching with handouts, hands-on practice session(s), use of distraction and play therapy are advisable as appropriate. The nurse should take the child’s developmental level into consideration when preparing and giving IV therapy. Parental/caregiver involvement is strongly recommended as parental anxiety has an impact on the child. 12. Infants and toddlers will usually require two people to insert an intravenous catheter. 13. A typical analgesic cream may be utilized to decrease pain and anxiety (physician order is required). 14. The amount and type of flushes must be included in the physician’s order. 15. Use at least two (2) patient identifiers prior to administering medications. EQUIPMENT: Small gauge needle - #21 to 27 Intravenous solution, as ordered by the physician Volume control set Infusion pump IV pole Intravenous start kit Tape Armboard Gloves Impervious trash bag Puncture-proof container Disposable apron (optional) Protective eye wear (optional) PROCEDURE: 1. Adhere to Universal Precautions. 2. Explain the procedure to the caregiver and patient (age appropriate). 3. Explain the importance of protecting the intravenous site and of not playing with the site, tubing, solution, pump and pole. When appropriate, have the child assist you by handing you the tape, etc. 4. Perform venipuncture. (See Administration of Intravenous Therapy in the Home, No. 9.01.) 5. Tape very securely, but not occluding vein, so that you can easily check site for signs and symptoms of complications. A sterile, transparent dressing may be used to cover the insertion site directly. 6. Discard soiled supplies in appropriate containers. 247
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