IV Initiation Flashcards
What are the names of the main veins in the hand?
- Digital Dorsal veins
- Dorsal Metacarpal veins
- Dorsal venous network
- Cephalic vein
- Basilic vein
What are the names of the veins in the forearm?
Cephalic vein
Median Cubital vein
Accessory Cephalic vein
Basilic vein
Median antebrachial vein
Wha should the nurse include in their assessment prior to initiation of an IV?
Emotional support, previous experience with IV,
Reason for IV
Arm placement preference
Planned interventions such as surgeries, blood transfusions. (Select appropriate catheter)
Allergies and lab data
Risk factors: Child, elderly, heart failure, low platelet count
What is a risk factor for children and the elderly with IV initiation?
large extracellular volume
What is a risk factor for IV initiation for patients with heart failure?
May be on a fluid restriction
What is a risk factor for IV initiation for a patient with renal failure?
Cannot eliminate excess ECF
What is a risk factor for a patient with low platelet count r/t IV initiation?
bleeding at the IV site
What are some key IV site selection considerations?
- Choose a vein that is visible, palpable and straight
- Choose the most distal site
- Condition of the vein/patient consideration
- Type of solution or medication to infuse
- Purpose of IV
- Duration of IV
- Duration of therapy
- Medical condition of the patient
- Select the smallest size catheter to accomodate Rx therapy
What are some IV initiation sites to avoid?
- Bruised or traumatized
- Extremities with impaired circulation
- AV shunts and fistulas
- Avoid wrist are because nerves and pain - lots of movement in that area
- Try to use non-dominant arm
- Do not use hands with vesicant medication infusions
- Avoid antecubital fossa – may limit range of motion, increase risk of phlebitis and infiltration, and interfere with blood sampling.
- Never start an IV in an arm affected by a radical mastectomy, edema, blood clot, infection or an arm with a fisula/shunt for use in hemodialysis.
- Avoid areas of flexion
- Avoid finger veins
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What are the purposes of initiating an IV?
- Restore/maintain fluid and electrolyte balance
- restore/maintain nutritional status parenteral nutrition)
- admin of meds, blood components/blood products, diagnostic reagents, general anesthesia or procedural sedation
- vascular access for emergencies
How many attemps per healthcare provider?
Two attempts and then get help
What is included in an IV initiation order?
- patient id
- fluid type
- volume
- infusion rate
- meds, dosage, route, frequency
- Type of solution
Any other comments such as: Discontinue if taking fluids well
Sometimes there are more than one solution ordered over a period. 1000 ml in 4 hours, then decrease to 1000 ml in the next 8 hours. (Document as IV #1 and IV #2.)
IV’s are often ordered over 24 hours
What are the steps to prepare for venipuncture?
Wash hands
Identify patient, provide patient teaching and provide comfort and privacy.
Choose a catheter size that would be appropriate for your patient
Age, what the IV is for, condition of vein
Loosen stylet from catheter by rotating motion (not back and forth)
Apply the tourniquet- 10-15 cm above site . Check for a radial pulse.
Choosing the vein – if possible, most distal site in non-dominant arm.
Promote venous distension – lower arm, open and close fist, warm, moist washcloth to arm
Release tourniquet temporarily.
Cleanse the site - 1 minute – circular motion. Allow to dry.
Reapply tourniquet
Apply gloves
Perform venipuncture
How far above the intended IV sit do you apply the tourniquet?
10-15 cm
What can you do to promote venous distension in addition to the tourniquet?
lower arm, open and close fist, warm, moist washcloth to arm, use blood pressure cuff
Gentle palpation of the vein – Place finger on vein, and gently start to press up and down with a slight bouncing action, after 20-30 seconds, the vein should expand slightly. Do not slap or flick the vein because the reaction to pain will cause the vein to contract.
What are the differences between arteries and veins?
