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IV THERAPY: I NITIATING IV T HERAPY P ART 3 Catherine Luksic, BSN RN.

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Presentation on theme: "IV THERAPY: I NITIATING IV T HERAPY P ART 3 Catherine Luksic, BSN RN."— Presentation transcript:

1 IV THERAPY: I NITIATING IV T HERAPY P ART 3 Catherine Luksic, BSN RN

2 I NITIATING IV T HERAPY Prior to procedure Check Physician’s order ! Check patient allergies Handwashing (min seconds) Sing “Happy Birthday” Equipment BE ORGANIZED Patient identification & assessment Patient education re: procedure Site selection

3 P HYSICIAN ’ S ORDER Date, time to start infusion. Solution to be infused, any additives ? Route of administration Dosage Rate Duration Signed by physician

4 P HYSICIAN ’ S O RDER Example: Infuse 1000 ml. D5W at 100 ml/hr Infuse 500 ml. 0.9 NS over 4 hours Infuse 20 meq Potassium Chloride in 100 ml. 0.9 NS over 1 hour Always check electrolytes, BUN, creatinine before administering potassium

5 P HYSICIAN ’ S ORDER Potential for Errors: Illegible handwriting. Verbal orders transcribed incorrectly. Use of abbreviations. Incomplete orders. Prescriber ignorance. Failure of nurses and pharmacists to challenge questionable orders.

6 INFECTION CONTROL & SAFETY Universal Precautions Higher risk w/ IV therapy direct vascular access risk of needle sticks Always follow OSHA standards Handwashing before and after all clinical procedures Wear gloves – blood/body fluid contact No artifical nails Never reuse catheter or needle Injection ports must be aseptically cleansed

7 INFECTION CONTROL & S AFETY : N EEDLESTICK P REVENTION NEVER recap used needle !! Count all needles used prior to and after procedure Dispose of all needles & syringes in “sharps” container puncture resistant Gloves will not protect against needle sticks

8 E QUIPMENT IV solution & tubing Insertion catheter/cannula (*radiopaque) Extension set and NS flush (5-10ml) Tourniquet (latex-free ?) Antimicrobial solution Chlorhexadine, Chloraprep unless allergic Electronic pump Tape Transparent dressing Gloves (powder-free, ? latex free)

9 S ITE S ELECTION 1. Type & Rate of solution to be infused 2. Duration of IV therapy 3. Cannula size 4. Vein integrity 5. Patient age, diagnosis 6. Patient preference Hand dominance 7. Patient activity level 8. AV fistula/post-mastectomy 9. Anticoagulant use

10 IV S ITE S ELECTION Hand veins (metacarpal) preferred site or forearm veins **INS recommendation: vasculature should accommodate gauge/length of catheter Choose straight vein w/ normal vasculature Distal veins first But proximal to any previous cannulation Non-dominant arm Avoid areas of flexion Armboard may be necessary to stabilize Choose vein that allows for ADL’s & movement

11 IV S ITE S ELECTION Avoid: Bruised, red, swollen veins Site of previous infiltration Area near surgical site Area near wound Limb affected by CVA, surgery or lymphedema Limb with AV fistula or graft Thin, small, curvy veins

12 IV S ITE S ELECTION Dorsal digital veins Small IV cannula, support w/ tongue blade or board Metacarpal veins Ideal site for IV use, primary choice Cephalic vein Accomodates large gauge IV cannula Accessory cephalic vein Accomodates large gauge IV cannula Basilic vein Appropriate choice, often overlooked

13 IV S ITE S ELECTION Sites of last resort Lateral or inner aspect of wrist – are thin and associated with bruising, infiltration Antecubital fossa – interferes with flexion Veins of legs, feet, ankles – can compromise circulation *dorsum of foot is best choice if necessary

14 C ATHETER S ELECTION Size of catheter (gauge) Purpose of IV fluids, ie: blood product Competency of veins g. Blood products, trauma (green) 20 g. Most commonly used (pink) 22 g. Pediatrics, elderly, small veins (blue) 24 g. Pediatrics, elderly (yellow) **color coded packaging

15 V ENIPUNCTURE P ROCEDURE : T IPS Talk to your patient, explain & reassure Assemble equipment ahead of time, be organized !! Inspect fluid, appearance, expiration date and sterility of equipment Adequate lighting Avoid bright, overhead lighting Flush air from tubing Prefilled 10ml syringe is best Select the most distal site if possible

16 V ENIPUNCTURE P ROCEDURE : T IPS Stabilize extremity Stabilize adjacent skin & vein Hold skin & vein taut Place tourniquet 4-6 inches above site If radial pulse not felt, tourniquet = TIGHT Ask pt. to clench/unclench fist May lightly tap vein Remove tourniquet before removing needle Single use Remove needle & place in sharps Check for adequate flow

17 V ENIPUNCTURE P ROCEDURE : T IPS Trouble visualizing vein ? Lower arm below ht. level x5 minutes Apply warm compress to area x5-10 minutes Light tapping of vein Ask pt. to clench/unclench fist Also ?? Use of BP cuff inflated to 30 mm/Hg

18 A GE RELATED CONSIDERATIONS Elderly Skin: dry skin, decreased elasticity, decreased turgor, thin & transparent skin Veins: walls are thicker & tougher, decreased elasticity, incompetent valves, varicosed veins (distended superficial veins) Hearing/visual impairment: may be a factor regarding patient education/understanding

19 V ENIPUNCTURE P ROCEDURE

20 C ATHETER I NSERTION Handwashing 1 st !! Maintain aseptic technique Equipment (prepared) & site selection Identify vein Apply tourniquet 4-6 inches above site Apply gloves Cleanse skin (center then outward 2-3 in.) w/ chlorhexadine, chloraprep, or alcohol/betadine x seconds, allow to air dry Do not use alcohol after betadine (negates the effect) Check for pt allergies first Do not touch site after cleansing Stabilize the vein w/ thumb or finger Perform venipuncture with IV catheter Needle bevel UP, degree angle No more than 2 attempts in same area

21 C ATHETER I NSERTION Look for “flash” of blood Slowly advance IV catheter ¼ - ½ inch Hold stylet in place & Remove tourniquet THEN remove stylet THEN advance catheter further Attach extension set, aspirate for blood return (if possible) then flush Assess for infiltration Apply transparent IV dressing to site Secure extension tubing w/ tape Use IV securement device Secure IV tubing w/ tape Label site w/ date-time-gauge-initials Assess site and patient !! Reassurance & documentation

22 C ATHETER I NSERTION Aspirate for blood return before administering meds Flush qshift or qd – check policy first 3-10 ml saline DO not force flush if meet resistance ! Does flushing cause pain ? Assess for signs of infiltration

23 IV I NSERTION VIDEOS New England Journal of Medicine – IV insertion video #1 (amola36) New England Journal of Medicine – IV insertion video #2 (amola36) IV insertion video #3 (craigmdo)

24 Peripheral IV insertion Demo 2 – alicec3 5:41

25 IV S ITE D RESSINGS Sterile Transparent is preferable Gauze is acceptable (inspect site & change q 24 hr.) Dressing change according to hospital policy Change dressing prn if soiled or loose Do NOT tape over transparent dressing Acceptable to Chevron tape w/ winged IV catheter set IV site must be removed and rotated every 72 hours (or according to policy) INS 2011 – rotate according to clinical condition CDC recommends site change every hours

26 IV SITE DRESSINGS

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28 N URSING D OCUMENTATION DATE/TIME (of insertion) LOCATION VEIN USED CATHETER SIZE (gauge used) INFUSION ( rate & solution; pump or grav.) ATTEMPTS MADE/LOCATION CONDITION OF SITE PATIENT TOLERANCE NURSE SIGNATURE

29 D ISCONTINUATION OF AN IV C ATHETER LPN can perform Gloves Stop IV infusion and detach Loosen tape Pull catheter out while holding site with 2x2 gauze (no alcohol - prolongs bleeding) Hold pressure x1 minute Apply dressing or bandaid, check site Check for intact catheter after removed, discard and document


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