Direct Preceptor Supervision is Required For:
All medication administration (all routes) at McKenzie Willamette Medical Center and all PeaceHealth Facilities.
- Any situation/procedure for which the preceptor feels supervision is necessary.
- Any procedure the student has done infrequently.
- Any procedure for which the student requests supervision.
- Venipuncture.
- Insulin and heparin dose verification.
- Drug calculation verification.
- Blood or blood product administration.
- Transfer of patient to or acceptance of patient from any special care area (e.g., OR, ED, ICU, Observation Unit, SSU).
- NG tube insertion.
- Transcription of physician's orders (must be countersigned by the preceptor).
- Validation of verbal or phone orders from physician and pharmacist (orders must be countersigned by the preceptor).
- Central line removal.
- Initiation and alteration of dosage of patient controlled analgesia (PCA).
- Initiation and alteration of dosage of continuous IV medication infusion (e.g., insulin, heparin,dopamine).
- Dosage alteration and bag/tubing change for epidural analgesia infusion.
Direct Preceptor Supervision is Required for the Following Until Such Time As the Student Has Demonstrated Competence:
- Invasive or complex dressing change.
- Removal of drain (e.g., Blake, JP, hemovac, penrose)
- Suture removal
LCC Nursing Integrative Practicum Program (formerly Preceptor Program) LCC Central Line Placement and Peripheral IV Policy
**LCC Students will participate in care of only those central venous catheters that have documentation of placement in the superior vena cava.
Central Venous Catheter (CVC) Placement, Confirmation, and Complications
It is the nurse’s responsibility to know the anatomical location of the tip of the central line. According to the Intravenous Nurse Standards, “Radiographic confirmation of correct catheter tip location should be obtained as soon as possible and prior to initiation of prescribed therapy. In an emergency situation, with a physician’s order, the line may be used prior to confirmation. Radiographic confirmation is obtained as soon as possible. Correct catheter tip location should be in the superior vena cava. When a central catheter is placed in a femoral vein, correct location should be in the inferior vena cava.”
CVC Prep and Initial Assessment Guidelines - Expectations of Students:
Must have knowledge of:
Type of CVC, number of lumens
Anatomical location of tip
Flushing routines required for this type of CVC (LCC students are required to follow INS Standards which state that lack of a good blood return from any port indicates malfunction. That port should not be used until adequate blood return has been reestablished). d. Date of last dressing change
Date of next IV tubing change
LCC/INS Standards regarding venipunture charting and solutions that can be administered through peripheral and midline catheters
LCC students should not administer continuous vesicant chemotherapy, parenteral nutrition exceeding 10% dextrose or 5% protein, or any solution/medication with a pH less than 5 or greater than 9 through a peripheral or midline intravenous catheter (INS Standards)
When charting venipunctures, the gauge and length of the catheter, anatomical location (name of vein and location), patient’s response to placement, and number of attempts should be included (INS Standards).