Lab 3: IV Insertion Flashcards
what techniques can be used to improve the visibility of the vein & increase the likelihood of a successful puncture
- tourniquet
- use of gravity
- pt open and clench their fist a few times
- light tapping/rubbing of the vessel
- heat application
how does a tourniquet cause vein enhancement
- traps blood in the extremity = vein dilates
what is a helpful tip regarding using a tourniquet (3)
- 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
how far above should the tourniquet be to the insertion site of a PIV
- at least 6”
how can you use gravity to cause vein enhancement
- lower the extremity below the lvl of the heart to promote venous pooling
how does light tapping/rubbing of the vein promote vein enhancement
- gentle rubbing w an antiseptic swab will cause blood to fill & dilate the vein
what options are available to use heat to promote vein enhancement
- dry and moist heat
what care must be taken when using heat to promote vein enhancement
- avoid excessive temperature that can burn the extremity
describe how to use heat to promote vein enhancement
- apply for approx 2-5 min (longer if necessary but no longer than 15 mn)
- reassess often (esp with older adults)
what is the preferred method for dry heat
- warm blanket
what is the preferred method for moist heat
- wash cloth dampened w warm water, placed on limb, and covered w a towel
what are factors that can affect vein enhancement
- bp (high or low)
- cold
- shock
- sclerotic veins
- dehydration
- anxiety/apprehension
- tourniquet application too tight or lose
what impact does cold and shock have on vein enhancement
- causes vasoconstriction
what impact do sclerotic veins have on vein enhancement
= loss of elasticity
what impact does dehydration have on vein enhancement
= flattened veins
what impact does anxiety/aprehension have on veins
= vasoconstriction
when should peripheral IV catheters be changed
- only when clinically indicated
what are clinical indications for change of peripheral IV (10)
- 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
what should you avoid when picking PIV site selection (8)
- 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
what is the first choice for PIV site selection
- dorsal and ventral forearm
why is the forearm the first choice for PIV site selection
- veins are longer & straighter
- ulna and radial bones provide natural splinting = permit pt freedome of arm movement and ability to participate in ADLs
how far above the wrist should forearm PIVs be and why?
- 2-3 finger breadths
- to avoid nerve injury
what should you assess first prior to IV placement
- assess distally first
- assess vessel condition (palpate and visual)
what is the second choice for PIV site selection
- dorsal portion of hand
what should you avoid in a PIV of the dorsal portion of hand
- the thumb
what is the 3rd choice for PIV site selection
- antecubital area
what is imp for placement of a PIV in the antecubital area
- try for 2 fingers width below or above
why are antecubital veins last choice for PIV site election
- located at multiple points of flexion and extension = increased risk of phlebitis
infusion into the dorsal portion of hand and antecubital area are difficult bc..? what is imp to note w these sites?
- 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
how often should a PIV site be assessed
- hourly if in use
- every shift if not in use
what should you assess when assessing a PIV site
- palpation
- visual assessment
- assess for discomfort by asking the pt (should not hurt!)
what are some common PIV complications (6)
- phlebitis
- inflitration
- extravasation
- ecchymosis
- hematoma
- thrombophlebitis
what can cause chemical phelbitis
- irritants/vesicants
- pH >9 or <5
what can cause mechanical phlebitis (3)
- flexion points
- large cannula
- inadequate securement
what can cause bacterial phlebitis (5)
- poor hand hygeine
- inadequate site prep
- compromise skin integrity
- breaks in aspectic technique
- non-occlusive dressing
what can cause infiltration/extrasvasation (4)
- poor site selection
- large catheter in small vein (catheter to vessel ratio)
- poor vein condition
- extremes in pH or osmolarity
what can cause ecchymosis/hematoma (3)
- unskilled clinican
- multiple attempts/manipulation
- inadequate pressure when device is removed
how should peripheral catheter be selected
- choose smallest gauge that will accommodate the prescribed therapy
- smallest device in biggest vein
why do you want the smallest gauge in the largest vein
- decreases the risk of infusion related complications
what does choosing the smallest gauge that will accommdate the prescribed therapy do? (2)
- increase hemodilution
- decrease endothelial damage
the smaller the catheter gauge, the ____ the bore
- larger
what are 16-18 G IV used for (2)
- larger vessels
- used for major trauma or rapid infusions
what are 20-22 G IV used for (4)
- most infusions
- minor trauma or surgery
- blood or blood components
- when rapid rates not required
what are 24 G IV used for (2)
- smaller vessels
- used in infants and older adults to prevent damage to fragile veins
what is a butterfly needle and what is it used for(3)
- similar to PIV
- but just for blood work
- not intended to stay insitu
describe how to use a PIV for bloodwork (7)
- 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
briefly describe how to do a PIV dressing change (4)
- 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)
how often should transparent dressings be changed?
5-7 days
- when clinically indicated (ex. blood, wet, etc.)
describe how to d/c PIV
- 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
what should you do if the tip of the catheter has broken off when d/c PIV
- alert MD as there is a concern for embolus
what should uou monitor the site for after d/c PIV? (4)
- redness
- pain
- drainage
- swelling
post-infusion phlebitis can occur how long after removal?
48-96 hr
how much tourniquet pressure should be used for older adults or people w fragile veins
- minimal pressure
- bc only a bit of pressure could rupture the veins
what are ideal sites for PIV
- veins that are palpable and bouncy
what should you do if a confused or pediatric pt is trying to pull out their IV (2)
- 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
what should you assess/determine prior to inserting PIV
- 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
what should you consider regarding the pt prior to PIV insertion (9)
- age
- co-morbidities
- allergies
- CVA
- mastectomy
- AV fistula
- impaired circulation
- wound
- pain
what should you consider when selecting a venipuncture site (4)
- dom/nondom arm
- vein length/width
- joints/nerves
- areas of flexion and extension (wrist, ACF)
what can you do to determine cathlon size needed (4)
dilate veins:
- tourniquet
- fist clenching
- dependent position
- warm compress
what supplies should you gather for PIV insertion (9)
- antiseptic wipe
- tourniquet
- appropriate sized cathlon
- tape
- gauze
- primed extension set
- dressing
- gloves
- NS flush
how should you prepare the site for PIV insertion (3)
- 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
what should you assess when applying tourniquet
- radial pulse should still be palpable
how should you assess the catheter for PIV insertion (2)
- remove needle in straight outward motion
- ensure push tab is facing up and catheter is seated back in notch
describe the steps to stabilizing the vein and performing venipuncture in PIV insertion (5)
- 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
what should you do after performing venipuncture (7)
- 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
what should you secure the PIV with?
- appropriate IV dressing
- label w date, time, initials
what should you note when securing the PIV (2)
- avoid use of tape close to/on insertion site
- ensure insertion site visible
describe how to select a site for PIV insertion
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
what should you note when palpating a vein for selection
- by press downward
- note resilient, soft, bouncy feeling as pressure is released
