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
