IV/IO

Question 1

4 common indication for the placement of an IC

Answer 1

1. administration of fluids
2. administration of medications of products
3. as a precaution in patients at risk for sudden collapse
4. a portal for drawing blood for studies

Question 2

outline selection site of IV

Answer 2

• start vitally, so that you may move more proximally if the attempt is unsuccessful
• the dorsum of the hand and the radial aspect of the wrist are often good sites for smaller IV placement
• ac fossa good for more proximal sites
• non-dominant arms are preferable
• upper extremities are generally favoured to lower the risk of DVT or phlebitis.
  in infants, scalp veins offer the best IV placement.

Question 3

in infants, __ veins offer the best IV placement.

Answer 3

in infants, scalp veins offer the best IV placement.

Question 4

why do people put lines in upper extremities rather than lower

Answer 4

upper extremities are generally favoured to lower the risk of DVT or phlebitis.

Question 5

when should you not put an IV in the site

Answer 5

• obvious trauma
• needs to be manipulated for another procedure
• obvious infection
• proximal venous obstruction
• presence of an AV fistula
• paresis of the involved limb.

Question 6

complications of IV placement

Answer 6

• pretty minor
• phlebitis at the site is reasonably common
• IV sites souhld be changed every 3 days
• hematomas or bruising

Question 7

how often should IVs be changed in hospitalized paatients?

Answer 7

every 3 days

Question 8

T/F gloves need to be sterile during IV placement

Answer 8

false. gloves should be worn for the entire procedure but do not need to be sterile.

Question 9

outline the equipment you need to prepare

Answer 9

• IV fluid and tubing
• the catheter itself
• something to clean the skin
• a tourniquet
• tape to secure the IV in place
• and a sterile dressing to place over it
• glove

Question 10

after prepping the equipment, what must you do before actually putting in the IV

Answer 10

• select the site

- disinfect the site with circular skin prep, starting at the inside and working outwards.

Question 11

t/f to prevent contamination, you should shave the area you are about to put the IV in

Answer 11

false. do not shave the area to prevent micro-abrasions. skin prep should be done with iodine, alcohol or chlohexidine and should be swabbed in a circular manner starting at the inside and working outwards.

Question 12

purpose of the tournique

Answer 12

to distant the veins, making them bigger and easier to cannulate.

Question 13

note:

Answer 13

If a site is selected in the forearm or hand, place the tourniquet approximately 3 inches below the AC fossa. If the IV is to be placed in the AC fossa, apply the tourniquet approximately half way up the biceps. Remember that the point of the tourniquet is to obstruct venous outflow causing distention of the veins, without obstructing arterial flow, which you are depending to fill the vein. If you can’t feel a distal pulse, the tourniquet is on too tight (although the patient will likely already have told you so). Also if the tourniquet is significantly painful for the patient it is probably on too tight, or is pinching somewhere.

Question 14

after putting on the tourniquet around 3 inches above the spot you will be placing the IV into, what else can you do to make the veins bigger?

Answer 14

ask the patient to clench and release their fist a few times.

• this will encourage more blood flow into the veins.
• can try gently tapping on the vein.
• if the patients are cold, a warm blanket may help the veins to dilate.

Question 15

vein characteristics to consider when placing the IV

Answer 15

you want straight veins that don’t have valves/branches/are crooked

Question 16

when can you do an IO?

Answer 16

An IO needle can be rapidly inserted in a patient in shock or a patient where peripheral or central venous access is difficult or impossible.

Question 17

in IOs, the ___ of fluid is the most common complications

Answer 17

Extravasation of fluid is the most common complication.

This rarely causes any problems unless the medication is caustic (calcium chloride, bicarb, etc). . Hematomas at the insertion site are also possible but uncommon. Infection and osteomyelitis are theoretical risks but are very uncommon as IOs are usually removed within a few hours (24- 48 hours max)

Question 18

where should IO needles not be places

Answer 18

where there is an overlying cellulitis, in a bone where a previous attempt has been made or in a rare bone condition osteogenesis imperfects.

Question 19

the most common site for insertion of an IO needle is the

Answer 19

proximal tibia. Other sites include distal tibia, distal femur, superior iliac crest and proximal humerus.

Question 20

the ___ ___ method is the most commonly employed technique for advancing the catheter.

Answer 20

The pushing off method is the most commonly employed technique for advancing the catheter.

Remember that when you see flashback, the tip of the metal stylet is within the vein. This does not mean, however, that the catheter is within the vein, because the stylet sticks out ~2 mm past the end of the catheter. (see Figure 2) The stylet / catheter unit therefore needs to be advanced a little bit further before the stylet is withdrawn and the catheter advanced. While keeping the vein immobilized, lower the catheter (flatten it out) until it is nearly parallel to the skin and then advance it slightly.