Lesson 4: IV Insertion and ABG

Question 1

indications for iv insertion

Answer 1

hydration, med administration/IV contrast, administration of blood products, surgery, and emergency care

Question 2

contraindications for iv insertion

Answer 2

Extremities with significant burns/edema, injury.
Cellulitis/Infection.
Do not perform distal to prior failed IV catheter insertion attempt.
Distal to area of preexisting phlebitis.
Impaired circulation – don’t use that extremity.
Bleeding diathesis.

Question 3

potential complications of IV insertion

Answer 3

Failure to properly cannulate a vein –> fluids/med infused into tissue, causing pain, irritation. Some meds can cause tissue necrosis.
Minor bleeding.
Thrombophlebitis.
Local site infection/cellulitis (catheters > 72-96 hours in place).
If aseptic technique in not followed –> bacteremia, septicemia.
Air emboli (if line not flushed properly)

Question 4

IV supplies and procedures

Answer 4

Prepare equipment: 24-gauge infant, 16-18 trauma patient.
If starting IV fluids, prime tubing.
After applying tourniquet (above elbow), look for “best vein”: largest, straightest, most peripheral, no valves.
Clean site and allow to dry (30 seconds).
Using your non-dominant hand, hold pt hand securely, while using thumb to retract skin distally, helping prevent vein from rolling.
Insert needle, bevel up, at 15-20 degree angle, until flash of blood appears in chamber.
After flash seen, lower needle (parallel to skin), advance 2-3 mm more, and advance (thread) catheter into vein.
Release tourniquet
Remove needle and use retraction device.
Apply gentle pressure to vein proximal to insertion site to prevent bleeding (happens anyway).
Attach IV fluids/or draw blood at this time.
Check that fluid is running freely, feeling for swelling, assessing pain.
Secure with tegaderm and tape. Label site (date, initials).

Question 5

do not try to insert iv more than how many times

Answer 5

2 times

Question 6

don’t forget what when discharging pt

Answer 6

removing iv

Question 7

examples of hard sticks

Answer 7

sickle cell and elderly

Question 8

ABG indications

Answer 8

To obtain arterial blood sample.
To monitor the severity/progression of a documented disease (COPD).
Arterial preferred over venous sample for ABG, ammonia level, carbon monoxide, lactate.

Question 9

Why arterial and not vein?

Answer 9

Diagnosis of acute dysfunction in carbon dioxide, oxygen exchange, or acid-base balance.

Question 10

abg contraindications

Answer 10

Bleeding diathesis
AV fistula
Severe peripheral vascular disease, absence of an arterial pulse
Infection over site

Question 11

abg complications

Answer 11

Hemorrhage/hematoma at site (prevent by applying pressure x 10min after procedure).
Thrombosis
Transient arterial spasm
Nerve damage

Question 12

Which Artery to Choose?

Answer 12

The radial artery is superficial, has collaterals and is easily compressed. It should almost always be the first choice.
Other arteries (femoral, dorsalis pedis, brachial) can be used in emergencies.

Question 13

Perform Allen test

Answer 13

Occlude radial/ulna artery as patient makes fist, after one minute release pressure off ulnar artery, and note if color returns to hand.

Question 14

rest of step for abg

Answer 14

Secure pt hand and place with wrist slightly extended 20-30 degrees (pillow under).
Equipment: can use pre-heparinized syringe kit if available, or you will need to flush syringe with heparin. Attach the needle to the ABG syringe, expel the heparin and pull the syringe plunger to the required fill level.
+/- anesthesia
Palpate the radial artery with your non-dominant hand’s index finger around 1cm proximal to the planned puncture site.
Holding the ABG syringe like a dart insert the ABG needle through the skin at an angle of 40-60 degrees over the point of maximal radial artery pulsation. (bevel face proximal).
Advance the needle into the radial artery until you observe blood flashback into the ABG syringe. (syringe should self fill).
Once the required amount of blood has been collected remove the needle and apply immediate firm pressure over the puncture site with some gauze. (10 min, followed by pressure gauze for a few hours after).
After removing needle, close syringe with rubber stopper, pushing up the blood to remove air, gently roll between palms.
Place sample on ice, label and transport to lab immediately.
Check on patient!

Question 15

air trapped in syringe will cause

Answer 15

dec in Pco2 and inc Po2. (stable 1-2 hours if on ice).

Question 16

if increased heparin in syringe

Answer 16

dec pH.