Diagnostic

purposes Therapeutic purposes Maintain patency of the intravenous access

1.Replace

fluids, electrolytes, calories, nutrition 2.Fluid and electrolyte balance 3.Acid-base balance 4.provide fluid, electrolytes, calories or nutrition to maintain homeostasis 5.transfuse blood and blood products 6.administer medications

Use distal veins of the arm first Use the clients non dominant arm whenever possible Select a vein that is:Easily palpated and feels soft and full Naturally splinted by bone Large enough to allow adequate circulation around the catheter

1.
2.

Avoid using veins that are In areas of flexion Highly visible, because they tend to roll away from the needle veins below a previous I.V. infiltration

3.

4.

veins below a phlebitic area

5. Sclerosed or thrombosed veins

6. AREAS of skin inflammation, disease, bruising, or breakdown

7 An arm affected by a radical mastectomy, edema, blood clot, or infection

8 An arm with an arteriovenous shunt or fistula. 9. In a surgically compromised or injured

For adults, vein in the hand and arm are commonly used For infants, veins in the scalp and dorsal foot are often used Larger veins are preferred for infusions that need to be given rapidly and for solutions that could be irritating. (e.g., medications )

1. 2. 3.

4.
5. 6.

Talk with patient/ concent Gather equipment Set up fluid and tubing on pump Wash your hands!! Select a vein Select a catheter size

8. 9. 10.

Apply tourniquet 5-6 inches above insertion site Never leave tourniquet on longer than one minute Then Remove tourniquet and prepare equipment

11.

12.

Cleanse skin with ANTSEPTIC SOLUTION Allow to dry for 30 seconds

13. Put on gloves!!!!

STARTING AN IV (CONT.)
14.Immobilize vein 15.Position needle 10-15 degree angle over site 16. Insert cannula. 17. Watch for blood backflow 18.Advance cannula 19.Only try twice before calling for help

Advance cannula while holding stylet stationary Release tourniquet!!

Stabilize the hub of the canula

22. Withdraw stylet while putting pressure on vein above injection site

Apply pressure above insertion site to slow bleeding

Stabilize the hub of the canula while inserting the tubing

Saline flush is already attached and tubing flushed and ready

23. Insert tubing or prn adaptor

It may get messy sometimes, but with experience this will be minimized

24. Flush with saline to clear tubing and insure IV has not infiltrated.
25. Stabilize tubing with tape to prevent IV from pulling out while applying the sterile dressing.

27.

Date, time and initial site and tubing

28.

Document!

Inflammation of the vein wallprecursor to sepsis What causes phlebitis?

IV left in too long Cannula too large Vein in poor condition Acidic solution or high osmolality Infusion rate too fast

 Leaking

of nonvesicant fluid into tissues surrounding the vein

Check

IV site every two hours

Complications

Nerve compression requiring fasciotomy

INFILTRATION

Administration of vesicant drug into surrounding tissues

Calcium Magnesium Phenergan Potassium chloride Antibiotics Chemotherapy drugs Vasopressors (Dopamine, epinephrine) Dextrose > 10% Lorazepam

Cellulitis: An acute, spreading, bacterial infection below the surface of the skin characterized by redness (erythema), warmth, swelling, and pain. Usually localized. Sepsis: clinical symptoms of systemic illness, such as fever, chills, malaise, hypotension, and mental status changes. Sepsis can be life threatening.

Poor insertion site Unsterile insertion of I.V line IV left in too long change q 96 hours! Hub contamination

Hand washing Sterile technique Proper Catheter size Proper Insertion site Site inspection every two hours Encourage patient to report any discomfort

Central venous catheter/line

A central venous catheter is a catheter placed into a large vein in the neck (internal jugular vein or external jugular vein)

Chest (subclavian vein)

Groin (femoral vein).

IT IS USED FOR

medication or fluids
blood tests (specifically the "mixed venous oxygen saturation"), cardiovascular measurements such as the central venous pressure.

Monitoring of the central venous pressure (CVP) Long-term Intravenous antibiotics

Long-term Parenteral feeding

Long-term pain medications

Chemotherapy plasmapheresis Dialysis Frequent blood draws when Peripheral venous access is impossible persistent requirement for intravenous access

Mal-position of the CVP catheter

Pneumothorax/hemothorax/hydrothorax
Infection Air embolism hemorrhage arrhythmias

Venous cutdown is an emergency procedure in which the vein is exposed surgically and then a cannula is inserted into the vein under direct vision. It is used to get vascular access in trauma and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein is commonly used, but antecubital and femoral vessels are also suitable.

Cellulitis hematoma Phlebitis perforation of the posterior wall of the vein venous thrombosis damage to the saphenous nerve

THANKS