Professional Documents
Culture Documents
Intravenous
Therapy
90-95% of patients in the
hospital receive some type
of intravenous therapy.
Vein Anatomy
- Tunica Adventitia
- Tunica Media
- Tunica Intima
- Valves
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Tunica Adventitia
the outer layer of the vessel
Connective
tissue
Contains the
arteries and
veins supplying
blood to vessel
wall
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Tunica Media
the middle layer of the vessel
Contains nerve
endings and
muscle fibers
The
vasoconstrictive
response occurs at
this layer
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Tunica Intima
the inner layer of the vessel
No nerve endings
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Valves
present in MOST veins
More in lower
extremities and longer
vessels
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Veins of the Upper Extremities
Digital Vessels
-Along lateral aspects fingers,
infiltrate easily, painful, difficult to
immobilize and should be your LAST
RESORT
Metacarpal Vessels
Digital
-Located between joints and
metacarpal bones (act
as natural splint)
-Formed by union of digital veins
-Geriatric patients often lack
enough connective / adipose tissue
and skin turgor to use this area
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Veins of the Upper Extremities
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Veins of the Upper Extremities
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
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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
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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
Have the patient close their fist (NO PUMPING) prior to stick
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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
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Dressing/Bag Changes
Changing dressings
Physician orders are 1 2 3 4 5 6 7
Gauze q TSM q 7 d
required if a peripheral 2d
than 3 days. 1 2
normally every 3d
3 24
hrs
If respiked or meds added
outside pharmacy
Changing Sites
It is best to have the
1 2 3 4 5 6 7
pharmacy add normally every 3d Every 7 d c MD order
medications to the
infusion bags under
laminare flow to reduce
contamination
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Central Venous Catheters
Percutaneous Tunneled PICCs Implanted Ports Dialysis
Insertion MD @ bedside MD in OR under MD/trained RN MD in OR under fluoroscopy MD in OR under
w/x-ray fluoroscopy @bedside w/x-ray fluoroscopy
confirmation confirmation
Location Visible externally. Visible ext. usually Visible externally Completely internal. Titanium or Visible externally.
Enters midway bet. around antecubital plastc port is implanted in a Arm or leg
subclavian, ext. clavicle and fossa, upper arm or surgically created pocket and placement
juglar,or int. nipple. Tunneled neck catheter is threaded into
juglar vein near under skin & subclavian or int. juglar vein.
clavicular area threaded through Access is through skin into self
subclavian or IJ sealing port using special non
coring needle
Material/Co Polyurethane Silicone Silicone / polyurethane Silicone catheter. Port is titanium Various materials
st $200-$400 $3500-$5000 $350-$500 or plastic w/self sealing diaphragm
$3500-$5000
Lumen 2-3 2-3 1-2 1-2 2-3
Sutured Yes/entire life Yes, until internal No Yes Yes
Dacron cuff
healed
Duration Short term 4-10 Long term Long term Long term Mid term
days
Flushes 5-10ml NaCl 5-10ml NaCl after 5-10ml NaCl after use 10ml NaCl followed by 4.5ml Done ONLY by IV
after use and use and daily and daily heparinized saline (adults- team or dialysis
daily 100units/ml; peds-10units/ml) after nurses
ea. use or monthly if not accessed
Brands/ Arrow Howe, Hickman, Broviac PICC, PIC, EDPC, Arrow Bard, Accces Port-A-Cath Bard, Tesio,
Names Triple Lumen, Howe, Gesco, PASV Vescath, Quinton
Subclavian, IJ
Discontinue MD or speically MD in OR Specially trained RN @ MD in OR MD in OR
Previous trained RN @ bedside Next
bedside
Central Venous Catheter
Sites
Implanted Port
(single or double
lumen)
Percutaneous (IJ-Int.
Tunnelled (Hickman)
Jugular)
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CVC Care/Maintenance
Percutaneous Tunneled
Notify MD and
document
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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 Bacterial
Mechanical
- Caused by irritation to - Caused by introduction
internal lumen of vein during of bacteria into the vein.
insertion of vascular access Remove the device
device and usually appears immediately and treat
shortly after insertion. The device w/antibiotics. The arm will be
may need to be removed and painful, red and warm; edema
warm compresses applied may accompany
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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
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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
Pulmonary edema- caused by rapid infusion
appropriately
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
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Troubleshooting
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Policy notes
KVO rate:
RNs and LPNs can start Adults - 10 ml/hr Only until rate
Pediatrics - 2-3 ml/hr order received
peripheral IVs after initial Neonates - 0.5-1 ml/hr
training and observation Verification required for:
by preceptor Insulin
Heparin
Potassium
Digoxin
LPNs CANNOT infuse Chemotherapy
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IV Medication Administration
Many medications require All Medications Cannot Be
patient monitoring that cannot Administered on All Units
be done on units where the General Care Units: Can give meds
requiring only basic physical
nurse/patient ratios are assessment data
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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.
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www.ins1.org
Infusion Nurses Society (INS)
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