General
To provide parenteral nutrition. To provide avenue for dialysis/apheresis. To transfuse blood products. To provide avenue for hemodynamic monitoring. To provide avenue for diagnostic testing. To administer fluids and medications with the ability to rapidly/accurately change blood concentration levels by either continuous, intermittent or IV push method.
What is the purpose of IV Therapy?
•If the patient reports a burning sensation during the injection of preservative-free normal saline solution, stop the injection and check catheter placement.
•If the catheter is in the vein, inject the preservative-free normal saline solution at a slower rate to minimize irritation.
•If the catheter isn't in the vein, remove and discard it; then select a new venipuncture site and, using fresh equipment, restart the procedure
What angle should you insert an IV at?
What is insert the catheter into the vein at a 15 to 30 angle. A large initial insertion angle can cause problem
What are the five types of central venous catheters?
What is PICC, Tunnelled (Hickman), Implanted port (double or single lumen), Percutaneous(Subclavian), and Percutaneous (IJ-Int. Jugular)?
Where is a central line inserted?
What is into the internal jugular, subclavian or femoral?
How should you start an IV?
Start with a vein at the most distal site
If possible, choose a vein in the non-dominant arm or hand
Choose a location that will help maintain ambulation, use of assist devices
Collaborate with older adults to choose the best location (whatever older adults means)
What are three different phlebitis/thrombophlebitis complications?
What is chemical, mechanical, and bacterial?
If you want to know more on them read below:
Chemical - Infusate chemically erodes internal layers. Warm compresses may help while the infusate is stopped/changed. Anti-inflammatory and analgesic medications are often used no matter what the cause
Mechanical - 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
Bacterial - 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
What can a rapid infusion cause?
What is pulmonary edema?
How long is a central line good for?
What is 10-14 days?
What vessels are accessed for pema cath (used for dialysis) insertion?
What is femoral, subclavian, and int. jugular?
Where should you not start an IV?
If chronic kidney disease, avoid using the upper arm or forearm veins
Avoid the side of breast surgery
Avoid arteriovenous fistula or graft
Avoid radiation therapy
Avoid extremity affected by lymphedema
Avoid extremity affected by stroke
Insert catheters away from open wounds
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
What is cellulitis?
What is caused by any free floating substances that require thrombolytic therapy for several months. Increased risk w/lower ext?
What is pulmonary embolism?
What must be performed after the insertion of the central line?
What is Xray to see correct location. Repositioning of the line MUST be done in sterile procedure.
What must be flushed and how many weeks when not in use?
What is heparinized saline every 4 weeks?
What size should you start an IV?
20G to 24G for most infusion therapies
catheters larger than 20G are more likely to cause phlebitis
Consider a larger gauge catheter of 14G to 18G for rapid transfusion
16G to 20G for rapid fluid replacement
What should you do if the patient reports symptoms of paresthesia while inserting the IV, such as radiating electrical pain, tingling, burning, prickly feeling, or numbness?
What is immediately stop the insertion procedure and carefully remove the catheter?
What is caused by air injected into IV system? Keep insertion site below level of heart
What is air embolism?
Before administering any medication, you must do what before?
What is aspirate for blood return?
What is a pro to having a central line?
What is directly into main circulation faster and multiple access ports.
•Verify order to start and maintain peripheral IV
•Review patient’s history for:
•allergies to antiseptic solutions, latex, and anesthetic agents
•skin alterations such as scars and tattoos
•History of IV drug abuse, diabetes, hypertension or structural vessel changes
•No pedal starts for Diabetic patients
•Physician order needed for pedal starts
•Pedal starts to be done only by IV team
What is starting the procedure for an IV?
What is the most common cause is damage to the wall during insertion or angle of placement. Where you should STOP the infusion and treat as indicated by pharmacy, medication package insert or drug reference book and you should notify the MD and document?
What is Infiltration/Extravasation?
What is it called when a patient has a severe infection that occurs to a system or entire body. Most often caused by poor insertion technique or poor site care. You should discontinue device immediately, culture and treat appropriately?
What is septicemia?
What are long term catheters?
What is implanted port and tunnelled (hickman)?
What is have inadequate peripheral veins
• need access for blood sampling
• require a large volume of fluid
• need a hypertonic solution to be diluted by rapid blood flow in a larger vein
• need to receive vessel-irritating drugs
• need a high-calorie nutritional supplement.
What is central venous therapy used for?