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NURS 3530 - Nursing Skills 3 > Lab 3: IV Insertion > Flashcards

Lab 3: IV Insertion Flashcards

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1
Q

what techniques can be used to improve the visibility of the vein & increase the likelihood of a successful puncture

A
  • tourniquet
  • use of gravity
  • pt open and clench their fist a few times
  • light tapping/rubbing of the vessel
  • heat application
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2
Q

how does a tourniquet cause vein enhancement

A
  • traps blood in the extremity = vein dilates
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3
Q

what is a helpful tip regarding using a tourniquet (3)

A
  • if having difficulty, use a double tourniquet
  • or manual BP inflated to just below the pts diastolic pressure & maintained at that pressure until insertion complete
  • or move tourniquet closer to insertion site
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4
Q

how far above should the tourniquet be to the insertion site of a PIV

A
  • at least 6”
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5
Q

how can you use gravity to cause vein enhancement

A
  • lower the extremity below the lvl of the heart to promote venous pooling
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6
Q

how does light tapping/rubbing of the vein promote vein enhancement

A
  • gentle rubbing w an antiseptic swab will cause blood to fill & dilate the vein
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7
Q

what options are available to use heat to promote vein enhancement

A
  • dry and moist heat
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8
Q

what care must be taken when using heat to promote vein enhancement

A
  • avoid excessive temperature that can burn the extremity
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9
Q

describe how to use heat to promote vein enhancement

A
  • apply for approx 2-5 min (longer if necessary but no longer than 15 mn)
  • reassess often (esp with older adults)
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10
Q

what is the preferred method for dry heat

A
  • warm blanket
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11
Q

what is the preferred method for moist heat

A
  • wash cloth dampened w warm water, placed on limb, and covered w a towel
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12
Q

what are factors that can affect vein enhancement

A
  • bp (high or low)
  • cold
  • shock
  • sclerotic veins
  • dehydration
  • anxiety/apprehension
  • tourniquet application too tight or lose
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13
Q

what impact does cold and shock have on vein enhancement

A
  • causes vasoconstriction
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14
Q

what impact do sclerotic veins have on vein enhancement

A

= loss of elasticity

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15
Q

what impact does dehydration have on vein enhancement

A

= flattened veins

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16
Q

what impact does anxiety/aprehension have on veins

A

= vasoconstriction

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17
Q

when should peripheral IV catheters be changed

A
  • only when clinically indicated
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18
Q

what are clinical indications for change of peripheral IV (10)

A
  • pain
  • redness
  • multiple downstream occlusion alarms w no visible cause
  • whenever there is suspicion of contamination
  • swelling
  • inability to flush and/or infuse w ease
  • induration
  • sclerosing of vessel
  • discharge
  • leaking site
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19
Q

what should you avoid when picking PIV site selection (8)

A
  • areas of flexion and extension
  • areas of skin breakdown, disease, bruising, and inflammation
  • scleoritc veins
  • highly visual veins (tend to roll)
  • veins damaged by previous use (phlebitis, infiltration)
  • knotted or tortuous veins
  • arm with an AV firstula
  • veins in an extremity that is edematous, compromised, or injured
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20
Q

what is the first choice for PIV site selection

A
  • dorsal and ventral forearm
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21
Q

why is the forearm the first choice for PIV site selection

A
  • veins are longer & straighter
  • ulna and radial bones provide natural splinting = permit pt freedome of arm movement and ability to participate in ADLs
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22
Q

how far above the wrist should forearm PIVs be and why?

A
  • 2-3 finger breadths

- to avoid nerve injury

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23
Q

what should you assess first prior to IV placement

A
  • assess distally first

- assess vessel condition (palpate and visual)

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24
Q

what is the second choice for PIV site selection

A
  • dorsal portion of hand
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25
Q

what should you avoid in a PIV of the dorsal portion of hand

A
  • the thumb
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26
Q

what is the 3rd choice for PIV site selection

A
  • antecubital area
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27
Q

what is imp for placement of a PIV in the antecubital area

A
  • try for 2 fingers width below or above
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28
Q

why are antecubital veins last choice for PIV site election

A
  • located at multiple points of flexion and extension = increased risk of phlebitis
29
Q

infusion into the dorsal portion of hand and antecubital area are difficult bc..? what is imp to note w these sites?

A
  • makes hourly assessments difficult (bc often covered by clothing)
  • imp to remove asap, to prevent further damage to the vessel
  • cause extreme discomfort to the pt
30
Q

how often should a PIV site be assessed

A
  • hourly if in use

- every shift if not in use

31
Q

what should you assess when assessing a PIV site

A
  • palpation
  • visual assessment
  • assess for discomfort by asking the pt (should not hurt!)
32
Q

what are some common PIV complications (6)

A
  • phlebitis
  • inflitration
  • extravasation
  • ecchymosis
  • hematoma
  • thrombophlebitis
33
Q

what can cause chemical phelbitis

A
  • irritants/vesicants

- pH >9 or <5

34
Q

what can cause mechanical phlebitis (3)

A
  • flexion points
  • large cannula
  • inadequate securement
35
Q

what can cause bacterial phlebitis (5)

A
  • poor hand hygeine
  • inadequate site prep
  • compromise skin integrity
  • breaks in aspectic technique
  • non-occlusive dressing
36
Q

what can cause infiltration/extrasvasation (4)

A
  • poor site selection
  • large catheter in small vein (catheter to vessel ratio)
  • poor vein condition
  • extremes in pH or osmolarity
37
Q

what can cause ecchymosis/hematoma (3)

A
  • unskilled clinican
  • multiple attempts/manipulation
  • inadequate pressure when device is removed
38
Q

how should peripheral catheter be selected

A
  • choose smallest gauge that will accommodate the prescribed therapy
  • smallest device in biggest vein
39
Q

why do you want the smallest gauge in the largest vein

A
  • decreases the risk of infusion related complications
40
Q

what does choosing the smallest gauge that will accommdate the prescribed therapy do? (2)

A
  • increase hemodilution

- decrease endothelial damage

41
Q

the smaller the catheter gauge, the ____ the bore

A
  • larger
42
Q

what are 16-18 G IV used for (2)

A
  • larger vessels

- used for major trauma or rapid infusions

43
Q

what are 20-22 G IV used for (4)

A
  • most infusions
  • minor trauma or surgery
  • blood or blood components
  • when rapid rates not required
44
Q

what are 24 G IV used for (2)

A
  • smaller vessels

- used in infants and older adults to prevent damage to fragile veins

45
Q

what is a butterfly needle and what is it used for(3)

A
  • similar to PIV
  • but just for blood work
  • not intended to stay insitu
46
Q

describe how to use a PIV for bloodwork (7)

A
  • stop infusion @1 min
  • flush with 3-10 mL NS
  • tourniqute
  • aspirate and discard approx 3 mL
  • aspirate blood for testing
  • transfer to blood tube, label, and requisition
  • flush PIV with min 3 ML to clear blood and lock
47
Q

briefly describe how to do a PIV dressing change (4)

A
  • perform hand hygeine & apply gloves
  • remove old dressing carefully while stabilizing the catheter
  • inspect site
  • cleanse w antiseptic swab stick
  • apply new transparent dressing with date

see skill 39-4 (5th edition) for full steps)

48
Q

how often should transparent dressings be changed?

A

5-7 days

- when clinically indicated (ex. blood, wet, etc.)

49
Q

describe how to d/c PIV

A
  • remove dressing and tape while stabilizing catheter
  • with dry gauze over site, apply light pressure and withdraw catheter keeping the hub parallel to the skin
  • hold pressure for 2-3 min, longer if on anticoag
  • tape gauze
  • inspect tip of catheter
  • monitor site
50
Q

what should you do if the tip of the catheter has broken off when d/c PIV

A
  • alert MD as there is a concern for embolus
51
Q

what should uou monitor the site for after d/c PIV? (4)

A
  • redness
  • pain
  • drainage
  • swelling
52
Q

post-infusion phlebitis can occur how long after removal?

A

48-96 hr

53
Q

how much tourniquet pressure should be used for older adults or people w fragile veins

A
  • minimal pressure

- bc only a bit of pressure could rupture the veins

54
Q

what are ideal sites for PIV

A
  • veins that are palpable and bouncy
55
Q

what should you do if a confused or pediatric pt is trying to pull out their IV (2)

A
  • put an obstacle in the way so they cannot get to it (ex. posi-mitt on right hand so their fingers can’t grasp the left PIV)
  • cover the PIV with as mesh dressing to hide/protect the site
56
Q

what should you assess/determine prior to inserting PIV

A
  • assess approp venous access device type (PIV or CVAD)
  • consider IV therapy to be infused
  • consider the pt
  • select approp venipuncture site
  • assess pt to determine cathlon size needed
57
Q

what should you consider regarding the pt prior to PIV insertion (9)

A
  • age
  • co-morbidities
  • allergies
  • CVA
  • mastectomy
  • AV fistula
  • impaired circulation
  • wound
  • pain
58
Q

what should you consider when selecting a venipuncture site (4)

A
  • dom/nondom arm
  • vein length/width
  • joints/nerves
  • areas of flexion and extension (wrist, ACF)
59
Q

what can you do to determine cathlon size needed (4)

A

dilate veins:

  • tourniquet
  • fist clenching
  • dependent position
  • warm compress
60
Q

what supplies should you gather for PIV insertion (9)

A
  • antiseptic wipe
  • tourniquet
  • appropriate sized cathlon
  • tape
  • gauze
  • primed extension set
  • dressing
  • gloves
  • NS flush
61
Q

how should you prepare the site for PIV insertion (3)

A
  • cleanse with antiseptic wipe in back and forth motion, covering an area slightly large than size of the dressing
  • do not retouch site after cleansing!
  • apply tournique 15cm (~6in.) above venipuncture site
62
Q

what should you assess when applying tourniquet

A
  • radial pulse should still be palpable
63
Q

how should you assess the catheter for PIV insertion (2)

A
  • remove needle in straight outward motion

- ensure push tab is facing up and catheter is seated back in notch

64
Q

describe the steps to stabilizing the vein and performing venipuncture in PIV insertion (5)

A
  • hold skin taught
  • insert bevel at 10-30* angle depending on vein depth
  • observe for flashback
  • lower angle after flashback observed to almost parallel to skin
  • advance needle approx 0.5* slightly to ensure within vein
65
Q

what should you do after performing venipuncture (7)

A
  • maintain skin traction while advancing plastic catheter only (one or two hand technique)
  • release tourniquet
  • stabilize catheter hub
  • press button to retract needle (avoid pulling needle out of catheter hub)
  • discard needle into sharps
  • connect primed extension set
  • flush
66
Q

what should you secure the PIV with?

A
  • appropriate IV dressing

- label w date, time, initials

67
Q

what should you note when securing the PIV (2)

A
  • avoid use of tape close to/on insertion site

- ensure insertion site visible

68
Q

describe how to select a site for PIV insertion

A

apply tourniquet and select vein:

  • use most distal site in nondom arm if possible
  • avoid areas painful to palpation
  • select a vein large enough for catheter placement
  • choose site that will not interfere w ADLs
  • use fingers to palpate the vein
  • promote veinous distension
  • avoid sites distal to previous venipuncture, bruised areas, areas of flexsion, hardened veins
  • avoid fragile dorsal veins in older adults

then release tournique

69
Q

what should you note when palpating a vein for selection

A
  • by press downward

- note resilient, soft, bouncy feeling as pressure is released

NURS 3530 - Nursing Skills 3 (4 decks)

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