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Revised Web IV Therapy
Revised Web IV Therapy
Intravenous
Therapy
90-95% of patients in the
hospital receive some type
of intravenous therapy.
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Vein Anatomy
- Tunica Adventitia
-
Tunica Media
Tunica Intima
Valves
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Tunica Adventitia
the outer layer of the vessel
Connective
tissue
Contains the
arteries and
veins supplying
blood to vessel
wall
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Tunica Media
Contains nerve
endings and
muscle fibers
The
vasoconstrictive
response occurs at
this layer
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Tunica Intima
One
No
layer of endothelials
nerve endings
Surface
for platelet
aggregation
w/trauma and recognition of
foreign object at this level
PHLEBITIS
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begins here
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Valves
More in lower
extremities and longer
vessels
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Metacarpal Vessels
-Located between joints and
metacarpal bones (act
as natural splint)
Digital
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Basilic
- Originates from the ulner side of
the metacarpal veins and runs
along the medial aspect of the
arm. It is often overlooked
becauses of its location on the
back of the arm, but flexing the
elbow/bending the arm brings this
vein into view
Medial Basilic
- Empties into the Basilic vein
running parallel to tendons, so it
is not always well defined.
Accepts larger gauge catheters.
- BEWARE of Brachial Artery/Nerve
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Purposes of IV Therapy
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-ACUVANCE
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Starting a Peripheral IV
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Have the patient close their fist (NO PUMPING) prior to stick
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- Peds: q 6hrs.
<22ga 1ml 0.9%NS followed by 1ml
heparinized (10units/ml) saline
- Adults: q 8hrs
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Dressing/Bag Changes
Changing dressings
TSM q 7 d
Gauze q
2d
24
hrs
normally every 3d
Changing Sites
1
normally every 3d
Every 7 d c MD order
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Tunneled
PICCs
Implanted Ports
Dialysis
Insertion
MD @ bedside
w/x-ray
confirmation
MD in OR under
fluoroscopy
MD/trained RN
@bedside w/x-ray
confirmation
MD in OR under fluoroscopy
MD in OR under
fluoroscopy
Location
Visible externally.
Enters
subclavian, ext.
juglar,or int.
juglar vein near
clavicular area
Visible externally
around antecubital
fossa, upper arm or
neck
Visible externally.
Arm or leg
placement
Polyurethane
$200-$400
Silicone
$3500-$5000
Silicone / polyurethane
$350-$500
Various materials
2-3
2-3
1-2
1-2
2-3
Sutured
Yes/entire life
No
Yes
Yes
Duration
Long term
Long term
Long term
Mid term
Flushes
5-10ml NaCl
after use and
daily
Done ONLY by IV
team or dialysis
nurses
Brands/
Names
Arrow Howe,
Triple Lumen,
Subclavian, IJ
Hickman, Broviac
Bard, Tesio,
Vescath, Quinton
MD or speically
trained RN @
bedside
MD in OR
Specially trained RN @
bedside
MD in OR
MD in OR
Material/Co
st
Lumen
Discontinue
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PICC (Peripherally
inserted
Central Catheter)
Percutaneous(Subclavia
n)
Implanted Port
(single or double
lumen)
Tunnelled (Hickman)
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Percutaneous (IJ-Int.
Jugular)
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CVC Care/Maintenance
Percutaneous
Tunneled
PICC
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CVC Care/Maintenance
Implanted Port
<1yr)
- followed by 4.5ml-5ml heparinized
saline
100units/ml for adults
10units/ml for peds
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Monitor and
document
site
condition:
Site Care
Hourly for
peds
Q 2 hr for adult
* Indicates
complication:
Infiltration
Phlebitis
Thrombosis
Cellulitis
Septicemia
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Infiltration/Extravasation
The most common cause is damage to
the wall during insertion or angle of
placement.
STOP INFUSION and
treat as indicated by
Pharmacy, Medication
package insert or drug
reference book.
Notify MD and
document
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Phlebitis/Thrombophlebitis
Chemical
- Infusate chemically
erodes internal layers. Warm
compresses may help while the
infusate is stopped/changed. Antiinflammatory and analgesic
medications are often used no
matter what the cause
Mechanical
Bacterial
- Caused by irritation to
internal lumen of vein during
insertion of vascular access
device and usually appears
shortly after insertion. The device
may need to be removed and
warm compresses applied
- Caused by introduction
of bacteria into the vein.
Remove the device
immediately and treat
w/antibiotics. The arm will be
painful, red and warm; edema
may accompany
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Cellulitis
Inflammation of loose
connective tissue around
insertion site.
- Caused by poor insertion
technique
- Red swollen area spreads from
insertion site outwardly in a diffuse
circular pattern
- Treated w/antibiotics
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Septicemia/Pulmonary Edema/
Embolism
Septicemia
- Severe infection that occurs to a system or entire body
- Most often caused by poor insertion technique or poor site
care
- Discontinue device immediately, culture and treat
appropriately
Pulmonary edema- caused by rapid infusion
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Troubleshooting
VAD broken
- PICCs may be repaired. All other devices must be replaced
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Policy notes
KVO rate:
Adults - 10 ml/hr
Pediatrics - 2-3 ml/hr
Neonates - 0.5-1 ml/hr
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Digoxin
Chemotherapy
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IV Medication Administration
Many medications require
patient monitoring that cannot
be done on units where the
nurse/patient ratios are
greater than 1:2
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IV Medication
Administration
Sample page
from the
Pharmacy med
administration
web site
See
APPROVED
FOR section.
You will find if
the medication
can be
administered
on
your unit.
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