IV Starts Flashcards
5 considerations when choosing a vein for IV insertion
Condition of the vein
Soft, spongy, full, ‘bouncy’
Purpose of the infusion
Rate of flow, pH, hyper/hypo/sotonic
Duration of therapy
>5-10 days consider CVC or PICC
Suitable location
Avoid areas of flexion
Appropriate for test, surgery or comfort
Safe site for insertion
5mm from wrist, consider nerves
Describe Cephalic and Basilica
Basillic aka ulnar
Cephalic is radial
What do you have potential to poke besides veins?
Nerves (Ulnar, medial, radial), arteries, tendons, ligament
IV insertion considerations r/t
CVA
Mastectomy
AV Fistulas
CVA- not to be used, patient unaware of complications. Veins may also have reduce flow r/t contractors
Mastectomy- Often involves lymph node removal and therefor reduced veinous flow. Risk of lymph edema
Av Fistulas - are high pressure and reserved for hemodialysis
Different gauges available and reason for use?
18 g – major surgery, labouring mother
20 g – surgical patients, blood and blood products
22 g – most adult patient needs
24 g – children and elderly
Use smallest gauge to meet needs of patient
6 techniques to ensure asepsis on IV insertion
Hand washing Wear Gloves Cleanse 2% chlorhexidine & 70% Alcohol Scrub for 30 seconds Allow to dry No retouch
How long can a tourniquet be in place and why
no more then 2 min r/t vein fatigue (no longer pools)
Strategies to increase ease of insertion
hot compress
dangling
gentle rub or tap
right pressure on tourniquet
Insert angle
15-30
What goes on IV dressing
date and initial
Strategies for starts on children
Involve child life worker Pre- teach parents Practice on teddies first Distraction (magic wand, magic gloves, imagery) pain management
4 common issues with IV starts
Failure to thread - could be from entering a sclerosed vein, hitting a closed valve, catheter is not yet far enough in the vein, or the catheter could be too large for the vein.
Missing the vein - could have occurred from the vein moving during insertion. Anchor more securely for success.
Hematomas - can occur during insertion if there is too much force with entering the needle in the vein, if the angle is too great, if the needle angle is not lowered once the needle is in the vein, if the veins are too fragile, or if the catheter is too large.
Venous spasm - can occur due to painful insertion, IV solution too cold, or if the patient has an emotional response to the procedure.
If you miss can you try again?
If you miss the vein you can pullback slightly re direct needle and try again as long as you don’t pull needle out.
What needs to be documented afterward
Date/time Size of device Location Initial ALL attempts
How often do you check the site
hourly
