IV Insertion Flashcards
What does initiation of peripheral intravenous mean?
It’s the insertion of a radio-opaque short IV catheter into a vein in the periphery
How long is a short IV catheter?
less than 3 inches
Purpose of IV therapy?
To introduce fluids, meds, or blood products into the intravascular system for the following reasons:
- maintain and/or correct fluid and electrolyte balance
- Admin blood or blood products
- To keep a vein open for emergency access
- provide supplemental/parental nutrition due to compromised gastrointestinal system
Know which veins are the best for IV insertion points (the vein graph)
- know what veins there are and where they are. there’s 2 diagrams w with vein pathways
- would be slide 15ish
Anatomy of a vein: what is the general pathway of the venous system?
Blood leaving the capillaries return to the heart via the venous system
- beginning with venules
- progressing to larger veins
- leads to superior and inferior vena cava
- then enters the right atrium
Describe what veins are + general characteristics
Highly distension thin walled vessels
- act as volume reservoir for circulatory system
- at any given time, contain about 50% of the body’s blood volume
- Veins have valves that keep blood moving back to the heart
3 layers of veins?
- Tunica External (outer layer)
- Tunica media (middle layer)
- Tunica intima (internal)
Describe the each of the layers of the veins (in 3 cards)
- know slides 15-18
Which vein layer does clotting and thrombus formation occur in?
Tunica intima (internal)
Add slide 13 (things to consider card)
What are considerations when selecting a vein?
- Purpose of infusion
- Duration of therapy
- Location
- Areas to avoid
What are infusion considerations when selecting a vein?
The infusion of large quantities of fluids, viscous fluids, hypertonic or highly irritating medications means that the larger diameter veins must be chosen in order to:
- allow for rapid infusion
- reduce the incidence of vascular irritability
- reduce the incidence of infiltration
- the above prevent restart occurrences
which veins are the most stable and reliable sites for insertion?
Generally, bigger veins = More stable and reliable.
- use the one furthest down the arm if possible, gives options that are higher up the arm if needed
What are considerations for long term IV therapy?
Veins must be preserved so its best to start as distal as possible on the forearm
- use the non dominate hand
- choose IV site proximal to the last site if there are problems with the initial site
Areas to avoid when inserting IV lines
- Areas of flexion (i.e antecubital fossa)
- Digital veins (fingers bc small and fragile sites)
- Inner aspect of wrist
- Lower extremities, unless ordered by GP or necessary by pts condition
- Areas where valves are palpated or where veins bifurcate
What are areas you absolutely want to avoid during IV insertion?
Below or above existing phlebotic or interstitial area
- on a limb w/an A-V fistula/graft
- Limb affected by a stroke
- on a mastectomy pt who have an a ill army dissection
- GP order is the only way an affected limb may be used, due to risk for lymphedema
Why are larger veins more desirable for insertion?
Larger diameter veins have greater blood flow and can accept a large amount of fluid rapidly
- in shock states, superficial veins readily collapse, resulting in poor IV infusions
What vein sites should be avoided as a general rule of thumb
Cord like, tortuous, scarred, or inflamed veins
What skin sites as a general rule of thumb, be avoided
Avoid veins in infected, inflamed, or injured areas
What is the Catheter selection dependent on?
Appropriate size of peripheral IV catheter followed by:
- purpose/duration of IV therapy
- Type of solution/med being administered
- Size and condition of pts veins
- Age and condition of patient
What rule of thumb should be followed for Catheter selection?
- Use the smallest gauge and the shortest length of catheter to achieve the desired therapy
- Ensure that the vein used is larger than the catheter
what is it important that the vein is larger than the catheter?
Ensures that blood flow around the catheter is sufficient to prevent vascular irritation from the catheter
- Ensures that there will be adequate hemodilution of the infusate
- Larger catheters will cause mechanical phlebitis sooner than smaller sizes
How does gauge sizing work for catheters?
The larger the number, he smaller the needle/gauge?
Slide 26, understand which gauge sizes are used for
What are the benefits of using smaller gauge intravenous catheters over larger gauges?
More comfortable and cause less mechanical irritation than a larger gauge
How many attempts does a practitioner have at inserting a IV?
After 2 unsuccessful attempts, another more experience and qualified individual must attempt the procedure
- unsuccessful attempts must be documented on the IV flow sheet/patient care record
- Date of insertion should be clearly transcribed at the IV site
Insert slide 29
What factors could enhance venous dilation and maximize the potential for a successful insertion:
- Tourniquet use
- Gravity
- Fist Clenching
- Tapping
- Warm packs
- Relaxation
Tourniquet guidelines for use?
- Should be tied only tight enough to occlude venous circulation (not arterial circulation).
- Place the tourniquet at least 4-6 inches above the
intended IV site. - Should not be left on for extended period of time –
always obser
How to utilize gravity in a IV insertion?
Allow the limb to dangle below the heart level for a few minutes before insertion
What needs to be kept in mind with fist clenching?
Remind the patient to relax their hand/arm prior to insertion of the IV catheter (if they don’t the vessel will occlude)
- Open and close their fist for a few seconds with the tourniquet on (instruct)
What needs to be kept in mind when tapping a vein?
Gentle tapping along the vein, not on.
- flicking and slapping could bruise fragile veins
Warm pack guidelines?
A warm towel is applied to the entire extremity and left in place no longer than 5-10 mins
- remove once tourniquet is in place
Relaxiation considerations before inserting IV?
(insert slide 34)
Cleaning guidelines for IV insertion?
- Clean the site with chlorhexidine (2% CHG in 70% alcoho)
- Apply cholrohexidine in a circular motion outward from insertion site from 2-4 inches ( as large as the dressing will be)
- Use friction to scrub site in this circular fashion
- Allow the chlorhexidine to dry
- Do not repalpate the skin
Catheter prepartion guidelines
- Remove IV catheter from package and inspect its integrity.
- Hold the catheter hub by the tab.
- Make sure catheter is secure.
- Maintain sterility of catheter throughout
Add slide 35
Add slide 38 (stabilizes patient)
- insert image on slide 40
Before insertion of an IV, what should be ready?
Prepare IV and tubing or saline lock prior to insertion
IV insertion technique and guidelines (slide 39-48)
Slide 49 (documentation crap)
What are potential causes of Hematoma formation due to IV insertion? (slide 50-51)
Where ideally would you like to insert within the vein?
Top surface and fullest and most round area.
- possible mistake would be to enter the side wall
What are possible causes of missing a vein during insertion (2) (slide 52)
- corrective action?
What are possible causes if you’re unable to thread the catheter after entering/inserting the vein?
(slide 53)
- corrective action?
We only go up to slide 54 (catheter feels flimsy upon insertion or advancement)
