Basic Intravenous Therapy

90-95% of patients in the hospital receive some type

of intravenous therapy. This presentation will enhance
your knowledge of how to care for them.
Vein Anatomy and Physiology
Veins are unlike arteries in that they are
1)superficial,
2) display dark red blood at skin surface and
3) have no pulsation
Vein Anatomy
- Tunica Adventitia
- Tunica Media
- Tunica Intima
- Valves
Tunica Adventitia
the outer layer of the vessel
Connective tissue
Contains the arteries and veins supplying blood to vessel wall
Tunica Media
the middle layer of the vessel
Contains nerve endings and muscle fibers
The vasoconstrictive response occurs at this layer
Tunica Intima
the inner layer of the vessel
One layer of endothelials
No nerve endings
Surface for platelet aggregation w/trauma and recognition of

foreign object at this level PHLEBITIS begins here

Valves
present in MOST veins
Prevent backflow and pooling
More in lower extremities and longer vessels
Vein dilates at valve attachment
Veins of the Upper Extremities
Cephalic (Interns Vein)
-Starts at radial aspect of wrist
-Access anywhere along entire length
(BEWARE of radial artery/nerve)
Medial Cephalic (On ramp to Cephalic Vein)
-Joins the Cephalic below the elbow bend
-Accepts larger gauge catheters, but may be a
difficult angle to hit and maintain
Basilic

- Originates from the ulner side of the metacarpal veins and runs along the medial aspect of
the arm. It is often overlooked becauses of its location on the back of the arm, but flexing the
elbow/bending the arm brings this vein into view.
Medial Basilic
- Empties into the Basilic vein running parallel to tendons, so it is not always well defined.
Accepts larger gauge catheters. - BEWARE of Brachial Artery/Nerve
Purposes of IV Therapy
To provide parenteral nutrition
To provide avenue for dialysis/apheresis
To transfuse blood products
To provide avenue for hemodynamic monitoring
To provide avenue for diagnostic testing
To administer fluids and medications with the ability to rapidly/accurately change blood
concentration levels by either continuous, intermittent or IV push method.
Types of Peripheral Venous Access Devices
Butterfly (winged) or Scalp vein needles (SVN) not recommended for
non compliant patient as it can easily penetrate the vein wall causing
extravasation.
We use these frequently for phlebotomy
Safety Over the needle catheters (ONC)
- PROTECTIV
-ACUVANCE
Starting a Peripheral IV
Finding a vein can be challenging
- Go by feel, not by sight. Good veins are bouncy to the touch, but are not always visible.
- Use warm compresses and allow the arm to hang dependently to fill veins.
- A BP cuff inflated to 10mmHg below the known systolic pressure creates the perfect tourniquet.
Arterial flow continues with maximum venous constriction.
- If the patient is NOT allergic to latex, using a latex tourniquet may provide better venous
congestion
- Avoid areas of joint flexion
- Start distally and use the shortest length/smallest gauge access device that will properly
administer the prescribed therapy
(BE AWARE: Blood flow in the lower forearm and hand is 95ml/min)
IV Start Pain Management
One of the most frequent contributors to patient dissatisfaction is painful phlebotomy and IV
starts
Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top of or just to
side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine without epinephrine
Topical anesthesia cream (ie EMLA) may be applied to children>37 weeks gestation 1 hr.
prior to stick. It might be a good idea to anesthetize a couple of sites
Have the patient close their fist (NO PUMPING) prior to stick
Make sure the skin surface cleansing agent (alcohol/chlorhexidine) is dry prior to stick.
Drawing this into the vein may stimulate the vasoconstrictive action of the tunica media
layer
Flushing Peripheral IVs
Use prefilled saline and heparin flush syringes located in PYXIS

Heparin flush concentrations available:

- 100u/ml (5ml in a 10ml syringe)
- 10u/ml (2ml in a 3ml syringe)
- Flushing intervals and amounts
- Peds: q 6hrs.
- <22ga 1ml 0.9%NS followed by 1ml heparinized (10units/ml) saline
- Adults: q 8hrs
- w/1ml. 0.9%NS [3ml heparinized saline for
Central Venous Catheters

Central Venous Catheter Sites

PICC (Peripherally inserted Central Catheter)

Implanted Port (single or double lumen)

Percutaneous(Subclavian)

Tunnelled (Hickman)

Percutaneous (IJ-Int. Jugular)

CVC Care/Maintenance
Flush after each access or daily for catheters>21ga, q 6 hrs <21 ga
-adults: 10ml saline
- peds/neonates: 5ml saline (preservative free for infants <1yr)

Transparent dressing change q 7 days & prn

Flush after each use and weekly while accessed; monthly when not acessed
- 10ml saline (preservative free for pts. <1yr)
- followed by 4.5ml-5ml heparinized saline
100units/ml for adults
10units/ml for peds
Transparent dressing/ access needle change q 7days

Site Care
Monitor and document site condition:

Hourly for peds

Q 2 hr for adult
* Indicates complication:
Infiltration
Phlebitis
Thrombosis
Cellulitis
Septicemia
1. Infiltration/Extravasation
-The most common cause is damage to the wall during insertion or angle of placement
STOP INFUSION and treat as indicated by Pharmacy, Medication package insert or drug
reference book.
-Notify MD and document
2. Phlebitis/Thrombophlebitis
Chemical
- Infusate chemically erodes internal layers. Warm compresses may help while the
infusate is stopped/changed. Anti-inflammatory and analgesic medications are often used no
matter what the cause
Mechanical
- Caused by irritation to internal lumen of vein during insertion of vascular access device
and usually appears shortly after insertion. The device may need to be removed and warm
compresses applied
Bacterial
- Caused by introduction of bacteria into the vein. Remove the device immediately and
treat w/antibiotics. The arm will be painful, red and warm; edema may accompany

3. Cellulitis
Inflammation of loose connective tissue around insertion site.
- Caused by poor insertion technique
- Red swollen area spreads from insertion site outwardly in a diffuse circular pattern
- Treated w/antibiotics
4. Septicemia/Pulmonary Edema/Embolism
Septicemia
- Severe infection that occurs to a system or entire body
- Most often caused by poor insertion technique or poor site care
- Discontinue device immediately, culture and treat appropriately
Pulmonary edema- caused by rapid infusion
Pulmonary embolism - Caused by any free floating substances that require thrombolytic
therapy for several months. Increased risk w/lower ext.
Air embolism- caused by air injected into IV system. Keep insertion site below level of
heart
Troubleshooting
Vascular access device will not flush/cant draw blood
- Evaluate for kink in tubing or catheter tip against vein wall.
Vascular access device (VAD) leaking when flushed
- Verify that hub access cap is connected correctly
Patient complains of pain while VAD being flushed
- Assess for infiltration
VAD broken
- PICCs may be repaired. All other devices must be replaced
Call IV therapy team member for any concerns or questions.
Policy notes
RNs and LPNs can start peripheral IVs after initial training and observation by preceptor
LPNs CANNOT infuse blood products or high risk IV medications.
IV Medication Administration
Many medications require patient monitoring that cannot be done on units where the
nurse/patient ratios are greater than 1:2
A patient can be moved to a unit where the ratio is appropriate for invasive/frequent
monitoring or another nurse can be brought to care for the patient during the med
administration
IV Medication Administration
Sample page from the Pharmacy med administration web site
See APPROVED FOR section. You will find if the medication can be administered on your unit.
Infusion Nurses Society (INS)
Professional Organization that sets the standards of care for clinicians practicing in the field
of infusion therapy.
Standards set by INS are reflected in our policies and procedures related to infusion therapy
for health care providers.
In a court of law, the standards set by the INS are used to assess the infusion clinicians
performance.