Lecture 02 Peripheral IV therapy

Question 1

What are 4 reasons for peripheral IV therapy?

Answer 1

1. Prevent or treat fluid and/or electrolyte imbalances
2. Administer medications
3. Administer blood products
4. Provide nutrition (Dextrose 12.5% maximum) – short term only

Question 2

What are common sites for peripheral IV?

Always use most distal access site, moving proximally if needed.

In adults and peds (3)

In peds (+2)

Answer 2

In adults and peds: Dorsum of hand, forearm “Intern’s vein”, Antecubitalfossa-cephalic and basilic veins

In pediatrics: scalp veins, feet/ankle veins

Question 3

What are types of IV Caths used in Adults?

In teens? Children? Infants?

Answer 3

Adults: 18~20 g

May use 22g in elderly or those with difficult peripheral access

Teens: 18~22 g

Children: 20~22 g

Infatns: 22~24 g

Question 4

Read me: IV insertion techinique highlits

Answer 4

Hand hygiene and use clean gloves.

Assemble supplies and have extra catheters available with NS flush and needless access device tubing.

Select vein

Prep site with (per facility)

Approach vein slowly and at a shallow/low angle with bevel of needle up

Observe for a flash of blood along the catheter in smaller caths and to/beyond the white button in larger ones.

With flashback, lower catheter to skin level, and advance whole unit slightly before threading catheter into vein. Be sure to stabilize.

Before retracting needle, release tourniquet.

Hold pressure below catheter tip as needle is retracted (slows blood flow)

Question 5

IV Site Assessments

When do you assess it in adults? (4)

In pediatrics? (5)

Answer 5

1. Beginning of shift
2. Prior to medication administration
3. Whenever accessed/flushed
4. Patient complaint of site pain/discomfort

In pediatrics:

1. Beginning of shift
2. Hourly, if infusing
3. Before every medication administration
4. Whenever accessed/flushed
5. Patient or parent request

Question 6

What’s the difference between infiltration and phlebitis?

Answer 6

Phlebitis is inflammation of the vascular endothelial wall…if accompanied by a blood clot it’’s know as thrombophebitis

Infiiltration:

1. Swelling of site
2. Cool to touch
3. Pale to pink
4. Tender to touch

Phlebitis

1. Swollen
2. Warm to touch
3. Erythematous
4. Tender to touch
5. “Cord” like vein feel with reddened line proximally from site

Question 7

What are causes of phlebitis?

Answer 7

Causes of phlebitis include:

1. •Catheter gauge
2. •Size of the vein
3. •Length of time the catheter is in place
4. •Type and pH of solution being administered
5. •Use of smaller veins or lower extremity veins (which should not ever be used unless an order is obtained)

Best prevention for both is to change per policy

Question 8

What are nursing actions for IV infiltration?

Answer 8

1. Remove IV
2. May insert another IV more proximally if site unaffected by infiltration.
3. Preferred – replace IV in unaffected arm or in peds another extremity
4. Apply warm pack as indicated and appropriate

Question 9

What are interventions for Phlebitis?

Answer 9

1. Remove IV
2. Insert another IV in unaffected arm
3. Avoid insertion of new IV in affected arm
4. Apply warm pack if appropriate