CS2 - Intravenous Insertion

Question 1

What is an IV?

Answer 1

passage of a catheter into a peripheral vein for access to the circulatory system

Question 2

When is an IV insertion indicated?

Answer 2

Administer:
-fluids
-medical treatment
-blood products
-parenteral nutrition support
Aid in diagnosis by inserting contrast or dye

Question 3

When is IV insertion contraindicated?

Answer 3

1. injury/recent trauma
2. rash/cellulitis
3. thrombosed vein or phlebitis
4. lymphedema/ hx of mastectomy
5. venous insufficiency
6. distal to a failed IV site (clotting )
7. vascular anomaly/fistula
8. When PICC line is more appropriate

Question 4

What are the potential complications of an IV insertion?

Answer 4

1. improper placement or catheter malfunction
2. infusion of substance into surrounding tissue
3. bleeding
4. thrombophlebitis
5. infection (local or systemic)
6. catheter embolization
7. air embolization - prep tube with NSS
8. PICC line - PE

Question 5

What areas are best for IV insertion and which should be avoided?

Answer 5

Areas with minimal bending/movement:
-cephalic vein
-basilic vein
-dorsal metacarpal veins
*avoid areas of bifurcations

Question 6

What areas are best for IV insertion in pediatric patients?

Answer 6

small saphenous vein
great saphenous vein
median marginal vein

Question 7

Why are IV’s typically inserted in the foot/lower extremity of pediatric patients?

Answer 7

1. least interference of bonding/breast feeding
2. easier to find veins
3. less chance of trauma/pulling
4. less likely to put in mouth
5. no concerns of venous insufficiency in infants
6. can use shield to further decrease chance of trauma

Question 8

What should be avoided in the veins during insertion?

Answer 8

Valves and bifurcations

Question 9

What size IV catheters should be used?

Answer 9

Infants - 24 gauge
Adults - 20 gauge
blood products - 16-18 gauge

Question 10

How long should the site of IV insertion be cleaned?

Answer 10

30 seconds

Question 11

How should the needle catheter be inserted into the vein?

Answer 11

bevel up and at a 15-20 degree angle

Question 12

What should be done when blood appears in the flash chamber?

Answer 12

lower needle parallel to the skin then thread the catheter into the vein based upon the type of catheter

Question 13

How is insertion different for an over-the-needle catheter

Answer 13

Insert the needle slightly further; secure the needle and thread catheter into vein

Question 14

How is insertion different for a self-shielding device?

Answer 14

Advance the entire device into the vein, remove the needle or initiate the retraction button

Question 15

What should be done after the catheter is inserted?

Answer 15

apply pressure proximal to the vein and limit bleeding, remove the tourniquet, then attach catheter to prepped IV tubing or Luer lock tubing

Question 16

If catheter insertion is unsuccessful, DO NOT…

Answer 16

reinsert needle into catheter - catheter embolization

Question 17

If the area of insertion becomes edematous or painful with infusion…

Answer 17

Remove the IV

Not going into vein, could causes necrosis, ischemia, etc.

Question 18

What is the post-procedure patient education after IV insertion?

Answer 18

educate on potential complications, signs and symptoms of infection and be sure to rotate the IV site every 96 hours; consider PICC line if long hospitalization

Question 19

What should be done if resistance is encountered when inserting the catheter?

Answer 19

valve; do not force the catheter into the vein
Remove the needle and select a new proximal location

Question 20

What should be considered in pediatric and geriatric patients?

Answer 20

small, fragile veins require a smaller catheter (24 gauge)
Be sure to secure catheter effectively in pediatric and confused patients