intravenous therapy Flashcards
why is IV therapy used?
for fluids, medication administration, blood administration, and/or hemodynamic monitoring.
where can IV therapy be used?
at a medical facility, at a patents home
reduces cost and time associated with medical facilities
types of needles
Angiocaths
(short peripherl)
- most commonly used
- short
- goes into the peripheral system
- used for intermediate use
- used for a short duration of time
- IV fluids, medications, and blood transfusions are used for these.
14G orange
largest in diameter
used for large amounts of fluids like in a trauma situation
gauge of an IV catheter needle
16G grey
used for large amounts of fluids like in a trauma situation
gauge of an IV catheter needle
18G green
great for blood admin
18 holes on a green golf course
gauge of an IV catheter needle
20G pink
good for most needs concerning the adult population
20G for age 20
gauge of an IV catheter needle
22G blue
avoid use during blood admin because it can destroy blood cells during the infusion
bid it a do
gauge of an IV catheter needle
24G yellow
used for ages 2-4
little fellows or elderly with poor vein access
types of needles
butterflys
- used for phlebotomy
- one time use for medication administration
When using a butterfly needle it can pose a risk of what towards the patient?
phlebitis
the inflammation of the veins creating swelling, redness
types of neeedles
central vascular access devices
CVADs
- implanted: hubuer portacath
- external tunneled (hickman, Broviac, Groshong)
- central venous catheter
- peripherally inserted central catheter
types of CVADs
to prevent infusion related complications, solutions and medications with an osmolarity greater than 900 mOsm/L are infused through one of the following CVADs.
type of CVAD
implanted huber portacath
- implanted into the skin and a non coring needle is used
- requires surgery for venous implantaion
- used for chemo/cancer patients and/or drawing blood
type of CVADexternal tunneled (hickman, broviac, groshong)
- inserted surgically into the subclavian or jugular vein
- used for permanent use
- goes into the heart that has ports to give meds or fluids
- give fluids, medication, nutrition
type of CVAD
central venous catheter
- used for several weeks
- short term
- placed by HCP at bedside, nurse assist
- pt is placed in trangelenburg position for insertion
- sutured at insertion site
type of CVAD
peripherally inserted central catheter
(picc line)
- long term antibiotic use
- pts may go home with this
- inserted in the anticubital fossa or the upper arm where the basilic
- it is advanced up till catheter tip reaches central vena cava
- dacron cuff coated in antimicrobial solution to prevent infections
- requies dressing changes
intraosseous access
- effective route for fluid resuscitation, drug drlivery
- into the bone
- most often used as a last resort in emergencies (trauma)
- physician or flight RN initiated, EMS
- 24 hour use
equipment needed for inserting an angiocath as a Saline Lock
-Angiocath(determine size needed)
-Start kit (tourniquet, tape, transparent dressing, antiseptic chlorhexidine sln,2x2 gauze, label)
-clean gloves
-J-loop with needless connector
-5 to 10mL prefilled syringe
-Stat-lock(stabilization device) if available and policy
Procedure: inserting an angiocath as a Saline Lock
- Verify the order
- Gather equipment
- Prepare Equipment with Saline infused J-Loop ready for connection with access.
- Identify and prepare patient/educate
- Purpose of VAD (meds, IVF, procedures)
- Notify nurse with S/S of complications (redness, pain, tenderness, swelling, bleeding, drainage/leaking)
- Apply tourniquet & locate vein
- Release tourniquet
- Don gloves and eye protection if necessary
- Place towel or pad under area
- Scrub site with alcohol or chlorahexadine & let dry
- Reapply tourniquet
- Stabilize vein & instruct pt prior to stick
- Insert needle BEVEL UP 10-30 deg. Angle
- Observe flashback & advance ¼ in
- Thread cannula into vein
- Release tourniquet & stabilize hub and apply pressure
- Connect iv tubing or j-loop to hub of cannula while stabilizing the device and flush
Some place a 2x2 under the hub in this process to catch any potential blood with the connection process. If used, the 2x2 is removed prior to dressing change. - Secure site with tape & drsg
- transparent dressing over hub (not J-loop) with insertion site covered and visible
- Label: Date, time, initials
- Statlock securement device or tape (5-7 days)
- Document
why should a nurse always start distally and move proximally when inserting a catheter?
when possible, place IVs at the most distal site. using a distal site first allows for the use of proximal sites later if the patient would need a venipuncture site change.
common sites to use for angiocath insertion
- hands
- arms
these sites utilize the cephalic, basilic, and median cubital veins. - head/scalp of newborns
sites that are last resorts for angocath insertion
- foot
- legs (increases risk of thrombocitis)
- neck
the use of the foot for an IV site is common with children but is contraindicated in adults because of the danger of thrombophlebitis.
things to look for when assesing an insertion site
- redness
- drainage
- bleeding
example of a documentation for inseting an angiocath as a saline lock
9/10/12 1522 18 gauge inserted to R forearm x 2 attempts. Remains a SL for medication needs. Patient tolerated well. Understood the purpose and therapeutics of need of IV cath insertion. Cath secured and labeled. —————–Nurse Nellie, RN
dressing changes
- changed every 5-7 days; per policy; if its wet, solied, rolled up, and/or if the integrity of the dressing is compromised.
- always include initials, date, and time
procedure: dressing change
- Hand hygiene and gloves
- ID patient
- Remove old IV site while securing device with nondominant hand
- Assess securement device’s need to be changed
- Cleanse site and allow to dry
- Apply new op-site dressing (Transparent Semipermeable Membrane-TSM)
- Secure hub and tubing with tape
- Label dressing change
do not do of iv therapy
What are Contraindications of IV Placements?
-
