IV insertion Flashcards
what does dec Level of consciousness indicate in relation to fluid volume (excess or deficit)
o Decreased LOC (lethargy, confusion, coma) severe ECV deficit, may occur with osmolality + acid base imbalances
o Restless + mild confusion occurs from excess or deficit of fluid volume
o Restless + mild confusion = occurs in FVD or acid-base imbalance
what assessments to do before inserting IV
- fluid balance
- allergies (iodine, latex, adhesive)
- Check if pt is to undergo procedures. want to ensure have right placement, not going to interfere with procedure,
- Assess lab data – helps determine priority assessments + baseline to see if therapy is effective
assessments for fluid vol
: body weight, clinical markers of vascular vol (urine output, bital signs, distended neck veins, cap refill, auscultation of lungs), markers of interstitial volume (skin turgor, dependent edema, mucous membranes), thirst, behavior + level of conciousness
gown consideration
make sure theyre in a gown with snaps (that they can take off without disconnecting an IV)
what structure do you apply a tourniquet above
over the humerus
over the antecubital fossa
your pt has sensitive skin or is hairy how can you modify the tourniquet
a. Can put over thin layer of clothes if skin sensitive or hairy
which veins are best
cephalic, basilic, or median cubital (on dorsal or ventral surfaces)
what area should be avoided and has high risk of nerve damage
a. Avoid lateral surface on wrist as risk of nerve damage
is multiple tapping or vigorous friction of a vein useful
a. Vigorous friction + multiple tapping of vein, especially in adults, causes hematoma and/or venous constriction
what are good methods for dilating the vein
Methods for dilating vein: put in dependent position, stroke distal to proximal, apply warm
are dorsal veins good as we want to use distal sites?
not for older adults
what sites to avoid (reasons to not use that arm)
i. areas of tenderness, redness, rash, pain or infection
ii. Extremity affected by CVA, paralysis, dialysis shunt or mastectomy
iii. Site distal to previous ventipuncture iste, schlerosed or hardened veins, ilfiltrate site, area of venous valves, or phlebotic vessels
- and dorsal veins for older adults
when reapplying the tourniquet what do you need to check before insertion of needle
check radial pulse (dont want to insert into artery by accident as if the circ was cut off you might not notice)
how to anchor vein
a. Anchor vein below site, thumb below site and gently stretch skin against direction of insertion 1.5-2in distal to site
what to tell pt to do before you insert
relax hand
what does the insertion feel like
sharp quick stick
do you insert slightly distal or proximal to chosen site
slightly distal to actual site in direction of vein
angle for initial insertion
10-30 degree angle
the stylet comes loose slightly can you put it back in and use it again
why or why not
no
risk of catheter shearing in vein + causing catheter embolization
when can you lower the angle
after blood return
after changing angle when do you loosen stylet
Insert catheter ¼ inch + loosen slylet in ONC (over the needle catheter)
why would you apply pressure above the insertion site once inserted but not covered w drsg
how do you do this
Apply pressure 3cm above insertion site (to stop flow) with middle finger of non-dominant hand, keep catheter stable with index finger
wht to document following insertion
a. Number of attempts (can’t be more than 2!)
b. Precise location
c. Flow rate
d. Method of infusion (gravity or EID)
e. Size + type, length + brand of catheter
f. Time infusion started
g. Pt response
wht to note on the site
29) Label drsg w date, time, VAD gauge size, initials
your IV site is: slowing of infusion, insertion site cool, pale + painful wht is wrong?
wht do you do
infiltration: Stop infusion + d/c IV, elevate limb, document, restart higher or other arm
intervention for phlebitis
Stop + d/c IV, warm compress over site, continue monitor for 48hrs for post-infusion phlebitis, document, restart above or other limb
what do you do if your IV site is bleeding? (not after insertion…just while infusing
Verify system intact, replace drsg if loose, restart IV if continued bleeding
pain w erythema and/or edema, streak formation + palpable venous cord
what is this on phlebitis scale
3
what are phlebitis of 2 s/s
2 = pain with erythema and/or edema
phlebitis of 4 s/s
4 = pain w erythema and/or edema, streak formation, palpable venous cord >1in, purulent drainage
wht sites cn you use in infnts beyond the median cubitl, brachial, cephalic
• 4 scalp veins + dorsal of foot also used in infants (in addition to usual 3)
which needle gauge sizes can you use for neonates and infants
o 26-24 gauge neonates
o 24-22 chilren
when using scalp vein how do you place the needle
• If using scalp veins, aim catheter downward toward heart so flow follows venous return
3 components that must be included in drs order for insertion of IV catheter
type of IV soln
- rate of infusion
- drs signature
excess isotonic soln can lead to what complication
circulatory overload
what can allow the catheter to move inside the vein and cause phlebitis
if improperly taped or not secured well by a drsg
6 reasons Iv may fail to infuse
eqpt not hooed up properly catheter no longer in vein kinked tubin positional iv clotted IV venous spasm
reasons Iv may b painful
allergic rxn infiltration mechanical or chemical phlebitis poor placement nerve tendon or ligament damage infection extravasation hematoma
4 reasons hematoma may occur w insertion
too much force
fragile veins d/t age, medical hx, meds
-inserting at too much of an angle or not lowering after initial insertion
-inappropriate eqpt choice
4 ways of dilating a vein
dangle the arm
relax the pt (deep breaths, distraction, visualization)
heat
gentle rubbing
leaving tourniquet longer than ___ minutes can cause what to occur
2-3
leads to vein fatigue and venous pooling
why is it nec to anchor the vein during venipuncture
the vein might move (roll) if not anchored
it decreases pain also
at what angle is the catheter inserted directly into the vein
15-30
what indicates the catheter is in the vin
flashback of blood and then, once advanced, continuation of blood up the extension tubing
what size cathteter meets most pt needs
1 inch long, 22 gauge
which vein is on radial surface of forearm
cephalic
vein on ulnar surface of forearm
basilic
key factors to consider when selecting site
condition of vein duration of therapy purpose of infusion medical Hx (AVF, CVAs, Sx, mastectomy) pt comfort and preference
which layer of the vein forms valves
tunica intima
2 reasons that lower extremities arent dsirabl for IV cannulation
- vins too small (inadequate hemodilution)
- inc risk of embolism and phlebitis d/t immobility
cause of catheter embolism r/t insertion
reintroducing the removable stylet which might tear the cathter
after IV initiated what info should be documented
location of site
gauge of catheter
date and time
signature
why should antecubital fossanot be used as primary source of IV therapy
theres higher risk of phlebitis and causing inc discomfort for pt
can IVs be started without drs orders
yes, in an emergency
hypo iso or hypertonic for fluid replacement post op
iso
hypo iso or hypertonic for Tx of hypovolemic shock
isotonic
what is an aberrant artery
how woul you know what it is
sometimes arteries are located superficially in unusual place. can distinguish it from reg vein by a pulse
which layer of a vessel is thicker in arteries than veins
adventitia
digital veins location and good under what circumstances
along lateral portions of fingers
not much blood supply so they are last resort
negatives about digital veins
small blood supply
diff to stabilize
painful on insertion
limit pt mobility
metacarpal veins found on the ___ of hand are good for what kind of therapy
dorsum
good for Short term
drawbacks of metacarpal
painful
limit mobility
diff to keep drsg dry and intact
cephalic veins why is it so good
lg size
naturally splinted by radius
where is acessory cephalic in relation to cephalic
is it gen visible
good site?
on posterior aspect of forearm and joins the cephalic below the elbow
it is palpable and not always visible
good site
basilic veins lg or sm?
location
lg
along ulnar surface of forearm and joins median cubital vein just below elbow
median cubital veins located?
good for what purpose
what length of Tx suitable
antecubital fossa
good for blood withdrawal or placement of lg gauge IVs in emergency
short term fluid admin only, change to other sitae ASAP
if there arent easy sites in upper body can you use lower extremity
risks of IV here
no. they need specific drs order
inc risk of embolism and phlebitis
how should a vein feel
A soft, spongy, full, unobstructed vein is desirable.
should you always choose a more visible vein
the deeper veins may be larger and hav more blood volume, might be a better choice
solns of what pH can be irritating
<5 and >9
where should you put IV for long term therapy (not CVAD)
as distal as possible but above the wrist
after entering a vein can you use it again
you can enter it again more proximal
should you alternate arms with each venipuncture
it helps to preserve veins
can you place an IV below a phlebitis
should not be done
why shouldnt side of mastectomy be used
they have impaired venous return d/t loss of lymph nodes
why not use arm of arteriovenous fistula or graft
can you use site far abovet the fistula or graft
inc P in venous circ.
no! whole arm cant be used
why not put IV in affected side of stroke pt
they might have paralysis of limg and as the skeletal muscles dec VR
- dec pain sensation
- might be dependent position that inc the effect of gravity–inc P might cause fluid to enter interstital space
what would 18 gauge needle be used for
major surgery or emergency
what would 20 gauge be used for
surgical pt
blood and blood products (gives best flow rate but can use smaller gauge if nec)
which gauge meets most pts needs
22 gauge
what guge to use for neonates kids and elder pts
24 gauge
position pt should be in for IV insertion. why?
lying down for vasovagal risk
what safety intervention for infants is best
bundle them up so they dont flail and for warmth
what to suggest toddler to do during insertion
blow bubbles, give task
praise the kid
when to chnge IV drsg (due to length of time)
7 days
who likely wouldnt require vasodilation before insertion
pt with HTN or very muscular arms
when might a tourniquet cause the wall of the vein to rupture
if pt has fragile veins
what site should you place tourniquet on. what else could you use
above antecubital fossa
if not effective reapply 4-6inches above intended venipuncture site
how tight should tourniwuet be
able to still palpate radial pulse
when applying heat how long is normally sufficient
5 mins is generally enough
how should skin be prepped
chlorhexidine or alcohol swabs for min of 30 seconds
how can you tell when youve entered an artery and what should you do
remove. firm P for minimum 5mins. drsg if nec
pt has catheter embolism as evidenced by SOB, chest pain, weak and rapid pulse, cyanosis, shock, cardiac arrest. what do
apply tourniquet above site and position pt on Lleft side
after opening the Iv package what should you check about your set
release the seal f the catheter from needle bypulling back gently then resecure
- check that vent plugs are secure
- check clamp
how often should IV be flushed
q shift and before and after meds
pt has pain, burning, itchin, unusual sensation at PIV site
immed remove IV and elevate, appl ice orheat as indicated by mediaction
swelling or blanching at site, cool to touch, pt may complain of pain or tightness
what do
immed stop Iv attempt withdrawal of fluid from IV then remove
follow med policy
extravasation policy if nec
pulmonary embolus interventions
give oxygen
semi fowlers
notify
pulm edema
oxygen
semi fowlers
slow infusion to slow rate or sline lock
notify
should the angle of insertion for elderly be inc or reduced
• Reduce angle for insertion (no subcut fat, veins more superficial)
gauges gen used for IV therapy of elderly
• 22-24 gauge appropriate for most therapies
what might cause venous spasm
tourniquet or the pt not being relaxed and being nervous
teaching to be included for pt regarding complications and when to alert nurse
o Teaching regarding observing for complications (red, swelling, feeling cool, wet, tape coming off, bleeding around site, IV not dripping, IV pump beeping) and to inform nurse right away.
(from my review) when giving vesicant drugs an you use an old site
yu should start a new site
can you use a peripheral IV site for a vesicant infused over >12hrs
no, either switch site or preferaby use CVC
what to do after removal of IV that had vesicant running through it
elevate, gentle pressure for 5 min
is it generally better to use cold or hot for extravasation
cold to dec metb demands. sometimes heat is indicated
