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INTRAVENOUS THERAPY

INTRAVENOUS THERAPY. Tammy Brock, RN MSN. OBJECTIVES. Indications for IV Therapy Different Types of IV Devices Differences in Fluids used for IV Administration Identify and Select Appropriate Veins Commonly Used for Venipuncture Discuss IV Therapy Risks and Complications. OBJECTIVES.

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INTRAVENOUS THERAPY

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  1. INTRAVENOUS THERAPY Tammy Brock, RN MSN

  2. OBJECTIVES • Indications for IV Therapy • Different Types of IV Devices • Differences in Fluids used for IV Administration • Identify and Select Appropriate Veins Commonly Used for Venipuncture • Discuss IV Therapy Risks and Complications

  3. OBJECTIVES • Discuss and Demonstrate IV Therapy Techniques for Insertion • Discuss Trouble-Shooting Tips

  4. Indications for IV Therapy • Establish or maintain a fluid and electrolyte balance • Administer continuous or intermittent medication • Administer bolus medication • Administer fluid to KVO (Keep vein open) • Administer diagnostic reagents

  5. IV Devices • Butterfly Catheter-Named after the wing-like plastic tabs at the base of the needle. • They are used to deliver small quantities of medicines, scalp veins in infants, and sometimes to draw blood. • These are small gauge needles. (23g)

  6. IV Devices • Peripheral IV Catheter • Mostly commonly used • Catheters are sized by their diameter, which is called a gauge. • The smaller the diameter, the larger the gauge. A 22-gauge catheter is smaller than a 14-gauge. • The greater the diameter, the more fluid can be delivered.

  7. Peripheral IV Catheter • To deliver large amounts of fluid, you should select a large vein and use a 14 or 16-gauge catheter. • To administer medications, an 18 or 20-gauge catheter in a smaller vein will do.

  8. IV Fluids • There are three main types of fluids: • Isotonic-Close to same osmolarity as serum. They stay inside the intravascular compartment, thus expanding it. • Can be helpful in hypotensive or hypovolemic patients. • Can be harmful. There is a risk of fluid overloading, especially in patients with CHF and hypertension. • Examples: Lactated Ringers (LR), Normal Saline (NS)

  9. IV Fluids • Hypotonic Fluids • Have less osmolarity than serum (has less sodium ion concentration than serum). • It dilutes the serum, which decreases serum osmolarity. Water is then pulled from the vascular compartment into the interstitial fluid compartment. Then, as the interstitial fluid is diluted, its osmolarity decreases which draws fluid into the adjacent cells. SO WHAT DOES THAT MEAN?

  10. Hypotonic Fluids • This process can be helpful if the cells are dehydrated. (i.e. diuretic therapy) • May also be used for hyperglycemic conditions, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments.

  11. Hypotonic Fluids • Can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells. • This can cause cardiovascular collapse and increased intracranial pressure in some patients. • Examples: 1/2NaCl, 2.5%Dextrose

  12. HYPERTONIC FLUIDS • Have a higher osmolarity than serum. Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. • Can help stabilize blood pressure, increase urine output, and reduce edema. • Dangerous in the setting of cell dehydration. • Examples: D51/2, D5LR, D5NS, blood products, and albumin

  13. VEIN SELECTION 1-Digital Dorsal Veins 2-Dorsal Metacarpal Veins 3-Dorsal Venous Network 4-Cephalic Vein 5-Basilic Vein

  14. VEIN SELECTION 1-Cephalic Vein 2-Median Cubital Vein 3-Acessory Cephalic Vein 4-Basilic Vein 5-Cephalic Vein 6-Median antebrachial Vein

  15. VEIN SELECTION • It is better to try to cannulate the most distal veins first. • Example: If you try to cannulate the antecubital vein and it is not successful and then you have a successful cannulation below that; any drugs or medication put through cannula may extravasate at the failed cannula site.

  16. VEIN SELECTION • Locate the vein with the straightest appearance. • Choose a vein that has a firm, round appearance or feel when palpated. • Avoid areas where the vein crosses the joints.

  17. CEPHALIC VEIN • One of the best veins available. • It tends to be large. • If you place the cannula too far down, you can have problems with mobility of the wrist joint.

  18. BASILIC VEIN • Often overlooked. • Often fairly large. • However, it can often roll and can have a lot of valves.

  19. DORSAL VEINS • The dorsal veins are often quite “hand-y”; but they can be quite small. • If the patient is elderly, look elsewhere first. The lack of turgor in the skin and loss of subcutaneous tissue make it quite difficult to cannulate these veins.

  20. DORSAL DIGITAL VEINS • Flow along lateral portion of fingers and are joined to each other by communicating branches. • Available for IVs accommodating a small gauge IV catheter (22, 24-gauge).

  21. METACARPAL VEINS • Flows upward along the radial border of the forearm producing branches to both surfaces of the forearm. • Because of their size and location, they provide an excellent site for IV infusion. • Venipuncture should be started at the most distal point on the extremity.

  22. CEPHALIC VEIN • Originates from either a plexus on the back of the forearm or dorsal venous network. • Readily accommodates large gauge IV catheters. • Available for venipuncture in the upper arm region.

  23. ACCESSORY CEPHALIC VEIN • Branches off from the cephalic vein just above the wrist and flows back into the main cephalic vein at a higher point. • Readily accommodates a large gauge IV catheter.

  24. BASILIC VEIN • Ascends along the ulnar portion of the forearm. It curves toward the anterior surface of the arm just below the elbow. It meets with the median cubital vein below the elbow. • Often overlooked because of its inconspicuous position.

  25. MEDIAN ANTEBRACHIAL VEIN • Flows upward along the radial border of the forearm producing branches to both surfaces of the forearm. • Because of their size and location, they provide an excellent site for IV infusion. • Venipuncture should be started at the most distal point on the extremity.

  26. TECHNIQUE • Preparation-Gather all the necessary supplies before you begin. • Prepare the IV fluid administration set. • Always maintain aseptic technique. • Perform the Venipuncture:

  27. PERFORM THE VENIPUNCTURE • Introduce yourself to your patient and explain the procedure. • Apply a tourniquet high on the upper arm, tight enough to visibly indent the skin. • Have the patient make a fist several times in order to maximize venous engorgement. • Lower the arm to increase venous engorgement.

  28. PERFORM THE VENIPUNCTURE • Select the appropriate vein. If you cannot easily see a suitable vein, you can sometimes feel them by palpating the arm using your fingers (not your thumb). The vein will feel like an elastic tube that “gives” under pressure.

  29. TIPS FOR VEIN SELECTION • If you are still unable to select an appropriate vein: 1. Tap the vein lightly, by gently “slapping” them with the pads of two or three fingers. 2. Cover the arm in a warm compress to help with peripheral vasodilitation. Place the compress on the arm for 10 minutes. Do not have the tourniquet on with the compress!!

  30. TIPS FOR VEIN SELECTION 3. Place the tourniquet from above the elbow and place it around the forearm. • Avoid the arteries.

  31. VENIPUNCTURE • Don disposable gloves. • Clean the area with alcohol prep and betadine swab. (Using alcohol after betadine will negate the effect of the betadine.) Using a circular motion and extending outward.

  32. VENIPUNCTURE • To puncture the vein, hold the catheter in your dominate hand. • With the bevel up, enter the skin at about a 30 degree angle.

  33. VENOPUNCTURE • Use a quick, short, jabbing motion. • After entering the skin, reduce the angle of the catheter until it is nearly parallel to the skin.

  34. VENIPUNCTURE • If the vein appears to roll, begin your venipuncture by applying a counter tension against the skin just below the entry site using your nondominant hand. • Advance the catheter to enter the vein until blood is seen in the “flash chamber” of the catheter.

  35. VENIPUNCTURE • After you receive the flashback, advance the plastic catheter on into the vein while leaving the needle stationary. • The hub of the catheter should be all the way to the skin puncture site. • The plastic catheter should slide forth easily. Do not force it. • Release the tourniquet.

  36. VENIPUNCTURE • Apply gentle pressure over the vein just proximal to the insertion site to prevent blood flow. • Engage your safety lock system on your needle. Dispose of the needle in an appropriate sharps container. • NEVER reinsert the needle into the plastic catheter while it is in the patient's arm. Reinserting the needle can shear off the tip of the plastic container causing an embolus.

  37. VENIPUNCTURE • Tape the catheter in place. • Label the IV site with date, time, IV catheter size, and your initials. • Monitor the site for infiltration.

  38. VENIPUNCTURE • Occasionally, you may inadvertently enter an artery. You will recognize this because the bright red blood is immediately seen in the IV tubing. • If this occurs immediately pull the IV catheter out and apply direct pressure to the site for at least 5 minutes.

  39. IF YOU ARE NOT SUCCESSFUL • If you do not get a flashback, slowly withdraw the catheter, without pulling it all the way out. Do not reinsert the needle into the catheter. • If after a few attempts, the vein is not entered, then release the tourniquet, place a gauze over the skin puncture site. • Try again in another arm.

  40. Occasionally, things can go wrong:

  41. COMPLICATIONS OF IV ADMINISTRATION • BRUISING • CELLULITIS • INFILTRATION • EXTRAVASATION • PHLEBITIS • SYSTEMIC COMPLICATIONS

  42. BRUISING • Blood can go underneath the skin, esp. common with the elderly. • Bruising may occur at any time during intravenous therapy.

  43. CELLULITIS • Infection: adhering to aseptic technique is vital in the prevention of intravenous related infections. Aseptic technique should be maintained at all times in dealing with intravenous therapy.

  44. INFILTRATION • The inadvertent administration on solution/medication into surrounding tissue. • Tissue damage can occur depending upon the solution/medication. • Regular monitoring of infusion sites, correct IV catheter:vein. Be careful of IV push medications.

  45. An escape of a substance into the tissue causing a disastrous outcome. EXTRAVASATION

  46. Inflammation of the vein associated with infusion. PHLEBITIS

  47. SYSTEMIC COMPLICATIONS • Systemic complications include sepsis, pulmonary thromboembolism, air embolism, and catheter fragment embolism.

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