Venous Access

Question 1

What are indication for an IV?

Answer 1

1- establish or maintain a fluid or electrolyte balance
2- administer continuous or intermittent medication
3- administer bolus medication
4- administer fluid TKVO
5- administer blood or blood components
6- administer intravenous anesthetics
7- maintain or correct a patient’s nutritional state
8- administer diagnostic reagents
9- monitor hemodynamic functions (CVP)

Question 2

What are 6 IV complications? Briefly explain

Answer 2

1) Infiltration: “the vein is blown/IV gone interstitial”; the catheter is delivering fluid outside the vessel
2) Infusion Phlebitis: inflammation of vein associated with trauma from inserting IV
3) Bruising (Hematoma): can occur with any needle poke, internal bleeding. consideration of risk for pt’s with low platelets (thrombocytopenia)
4) Infection of vein - phlebitis: infection d/t lack of or improper infection control; risk of cellulitis
5) Extravasation: administration of toxic substance into the tissues causing necrosis
6) Embolism (air or catheter): infusing air from the lines that will affect gas exchange [~70cc’s/70mLs]; shearing at the end of the catheter

Question 3

Discuss three types of Needle?Catheter Systems

Answer 3

1) catheter over the needle
- most common
2) needle over a guide wire/catheter
- insert needle, insert guide wire, remove needle, insert catheter over guide wire, remove guide wire (needle + guide wire removed, catheter in place in vessel)
- improves placement, minimizes risk of cutting off flow causing back pressure
3) butterfly catheter
- used to lay flat on skin and hold in place
- deliver small quantities; used in pads/neo; small gauges (23 gauge)

Question 4

Gauge size indication for use

Answer 4

14-16 (larger size) if patient at risk of developing blood transfusion, trauma, or shock
18-20 for routine purposes, may give fluids to increase BP through this size gauge [20 gauge good for routine adult needs, 20 most common for IV]
22-24 (smaller size) for chemotherapy or radiopaque drugs [22 most common for ABG]

Question 5

What angle do you insert the needle for IV puncture?

Answer 5

5-30 degree angle with bevel up

Question 6

What is the difference between macro and micro drip IV sets?

Answer 6

The amount of drops per mL. With a macro drip, we get 10-15 drops for ever 1mL (rapid fluid delivery, routine fluid delivery, KVO). With micro drip, we get 60 drops for every 1mL

Question 7

Factors for IV site selection

Answer 7

1- age
2- sex
3- muscle mass
4- skin turgor & elasticity
5- skin colour

Question 8

When selecting a vein for IV access, avoid …

Answer 8

1- joints
2- inner aspect of wrist
3- lower extremities
4- scars

Question 9

Order for IV access

Answer 9

• site selection & preparation
• tourniquet
• inject needle, once needle in the vein, advance the catheter over the needle
• release tourniquet
• apply pressure, remove needle
• connect plastic catheter, adjust flow
• secure site (label with date, time, practioner initials)