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Intravenous-Therapy
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INTRAVENOUS THERAPY
IV Statistics 85% of all
hospitalized patients have some type of IV therapy
118 million IV catheters inserted yearly
COMPLICATIONS
PHLEBITIS Inflammation of the vein
wall—precursor to sepsis What causes phlebitis?
IV left in too longCannula too largeVein in poor conditionAcidic solution or high
osmolality Infusion rate too fast
PreventionsChoose vein appropriately
Location
Size
Soft, spongy, resilient
No pain or tenderness or redness with injection
INFILTRATION Leaking of nonvesicant fluid into
tissues surrounding the vein
Check IV site every two hours
ComplicationsNerve compression requiring
fasciotomy
EXTRAVASATION Inadvertent administration of vesicant drug into
surrounding tissues
Calcium Magnesium Phenergan Potassium chloride Antibiotics Chemotherapy drugs Vasopressors (Dopamine, epinephrine) Dextrose > 10% Lorazepam Dilantin
INFECTION Cellulitis: An acute, spreading, bacterial
infection below the surface of the skin characterized by redness (erythema), warmth, swelling, and pain. Usually localized.
Sepsis: clinical symptoms of systemic illness, such as fever, chills, malaise, hypotension, and mental status changes. Sepsis can be life threatening.
INFECTION > 200,000 infections per year
More than 60,000 patients die annually from bloodstream infections caused by intravenous therapy
Cost for one patient is $56,000
Annual US total = $2.3 billion
Causes Poor insertion site
Squad starts
Unsterile start
IV left in too long—change q 96 hours!
Hub contamination
Cellulitis
Prevention Hand washing Sterile technique Catheter size Insertion site Site inspection every two hours Encourage patient to report any
discomfort
Patient’s Worst Nightmare!!!!
Other sites to avoid include:
• veins below a previous I.V. infiltration
• veins below a phlebitic area
• sclerosed or thrombosed veins
• areas of skin inflammation, disease, bruising, or breakdown
• an arm affected by a radical mastectomy, edema, blood clot, or infection
• an arm with an arteriovenous shunt or fistula.
Muscle Man IV!
STARTING AN IV1. Talk with patient2. Gather equipment3. Set up fluid and tubing on pump4. Check patient order and ID band &
allergies5. Wash your hands!!6. Select a vein7. Select a catheter size
8. Apply tourniquet 5-6 inches above insertion site9. Never leave tourniquet on longer than one minute10. Then Remove tourniquet and prepare equipment
STARTING AN IV (CONT.)
11. Open equipment and connect flush to J-loop
12. Loosen caps of IV and J-loop but leave in place for sterility. (They should just slide off when you pick up the device).
13. Cleanse skin with chlorhexidine gluconate solution in back & forth motion X 30 seconds
14. Allow to dry for 30 seconds
15.Put on Gloves!!!
16. Immobilize vein17. Position needle 10-15 degree angle over
site18. Insert cannula bevel up19. Watch for blood backflow20. Advance cannula21. Only try twice before calling another RN
to help
STARTING AN IV (CONT.)
Advance cannula while holding stylet stationary
Release tourniquet!!
22. Withdraw stylet while putting pressure on vein above injection site
Stabilize the hub of the canula
23. Insert tubing or prn adaptor
Apply pressure above insertion site to slow
bleeding
Stabilize the hub of the canula while inserting the tubing
Saline flush is already attached and tubing flushed and ready
It may get messy sometimes, but with experience this will be minimized
24. Flush with saline to clear tubing and insure IV has not infiltrated.
25. Stabilize tubing with tape to prevent IV from pulling out while applying the sterile dressing.
26. Apply clear sterile dressing. Cover site and hub, not tubing
Leave the end of the hub of the canula outside the dressing so that tubing can be changed without removing the dressing.
27. Date, time and initial site and tubing
STARTING AN IV (CONT.)
28. Document!
What is wrong with this picture?
Dartmouth
Power Port
CONTINUOUS INFUSION: SECURING THE NEEDLE
When starting a continuous infusion, you must secure the right-angle, non-coring needle to the skin. If the needle hub is flush with the skin, apply a transparent semipermeable dressing over the entire site. If the needle hub isn’t flush with the skin, place a folded sterile dressing under the hub, as shown. Then apply adhesive skin closures across it.
Secure the needle and tubing, using the chevron-taping technique with sterile tape.
Apply a transparent semi-permeable dressing over the entire site.
http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=relatedhttp://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related
