IV Catheterization VTHT 1491- Special Topics Ms. Liddell CTVT:
Chapter 20 (pg: 607-610) VTDRG: Chapter 8 (pg: 349-351)
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Learning Objectives Describe the procedure for placement and
care of a peripheral intravenous catheter Describe the indications
and procedure for placement and care of a jugular catheter List
requirements for monitoring of patients with intravenous
catheters
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3 IV Catheterization Used for: Temporary access for
medications, fluid and electrolyte replacement therapy, or
transfusion of blood products
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IV Catheterization Catheter site selection depends on:
Available vessels Condition of vessels Patient Expense Urgency of
situation
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5 IV Catheterization Complications Phlebitis Local cellulitis
Septicemia Collapsed veins or hematomas rendering veins
unusable
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6 IV Catheterization Types Winged needle (butterfly) catheter
Plastic wings on needle shaft facilitate placement and taping (if
needed) Tubing extending from needle to syringe connector port
allows maneuverability Is for short-term use Used for: blood
collection Administration of non-irritating medications Moves out
of vessel easily because of needle
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IV Catheter Types Over-the-needle catheter Used primarily for
peripheral vein catheterization Come in many different sizes
(gauges) that coordinate (color) with needle sizes Needlepoint
extends beyond catheter tip for entry into vein Once catheter is
placed, needle is withdrawn from insertion site MOST COMMON IV
CATHETER USED
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10 IV Catheter Types Through-the-needle Usually longer than
over-the-needle catheters (8- to 12-inch) and are primarily used
for jugular vein Once catheter is placed, needle is withdrawn from
insertion site and a needle guard is placed over needle Protects
needle from sticking animal and shearing catheter
http://www.youtube.com/watch?v=AxSCCwd N1nI
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IV Catheter Types Multi-lumen catheter Have two to three
separate lumens allowing simultaneous infusions at one catheter
site Placement is usually completed per- cutaneously with a
guidewire More expensive than other catheters Used primarily in
Jugular catheterization
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13 Peripheral Catheterization Sites Dogs and cats Cephalic,
medial saphenous (cat) and lateral saphenous (dog) 20-gauge,
22-gauge, and 25-gauge, 1- to 1.5-inch catheters 20-gauge,
22-gauge, 23/25-gauge, ` 5/8 butterfly catheters
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Peripheral Catheterization ALWAYS REMEMBER Start on the distal
portion of the limb and move proximal for all catheter
placement
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15 Peripheral Vein Butterfly Catheterization Supplies Clippers
Antiseptic scrub and solutions Catheter A syringe filled with flush
heparinized saline Saline Tape and/or non-absorbable suture (not
always used)
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Butterfly Catheter Placement Procedure Venipuncturist can hold
the wing of the catheter up or down when placing catheter Once in
vessel, blood will flow back into the clear tubing Syringe can be
attached to tubing end and blood can be pulled into syringe for
blood draw Digital pressure required from restrainer Syringe can be
attached to tubing end and medications or flush can be administered
through tubing Release of digital pressure required from
restrainer
18 Peripheral Vein Catheterization Supplies Clippers Antiseptic
scrub and solutions Catheter A syringe filled with flush
heparinized saline Saline Injection cap or T-connector Tape and/or
non-absorbable suture Bandage material
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19 Peripheral Vein Catheterization Procedure Shave area of
insertion site Surgical prep with antiseptic scrub and solution
Aseptic technique is important to prevent infection A relief hole
may be made with a #11 blade or 20- gauge needle to reduce friction
Indicated in severely dehydrated patients or patients with tough
skin Occlude vein proximal to insertion site with tourniquet or an
assistant
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21 Peripheral Vein Catheterization Procedure cont.. Grasp
distal portion of leg and extend it to help immobilize the vein
With bevel up, insert catheter through skin or relief hole at
approximately 15- degree angle Advance catheter into vessel; when
blood flashes in (hub), needle and catheter are advanced together
as a unit for an additional 1-4 mm
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23 Peripheral Vein Catheterization Procedure cont.. Hold needle
still and advance the catheter ONLY into vessel Cap catheter with
an injection cap or T- connector and flush catheter Secure catheter
with tape wrapped around hub of catheter and then around leg
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Taping in of Peripheral Catheters Taping techniques vary from
person to persona and hospital to hospital There is not one right
way to tape a catheter in Always remember to: Secure the catheter
hub and injection port Never secure tape to tightly Be sure
patients leg is dry prior to applying tape
29 Jugular IV Catheterization Procedure Site chosen is shaved
and surgically prepped Wipe or spray with betadine solution, left
to dry on 2-5 ml of lidocaine given ID over and above insertion
site Create sterile field by opening sterile gloves, and laying
opened catheter on gloves Other items are either placed on sterile
field or in cold sterilization tray Sterile gloves are worn
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30 Jugular IV Catheterization Hold catheter in dominant
handother gloved hand occludes jugular Insert catheter into skin at
approximately 45- degree angle, toward heart Flash of blood in hub
indicates vessel is hit, advance centimeter more Hold needle still,
sliding catheter into vessel; remove needle Check to make sure vein
is still catheterized by applying digital pressure Attach a PRN or
T-port and suture catheter into place
36 Jugular IV Catheterization Apply small amount of
antibacterial ointment before placing wrap over catheter Wrap neck
or apply stents over catheters to stabilize them and to prevent
them from getting rubbed out
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Examples of four types of IV catheters. Catheter A is a
butterfly; catheter B is an OTN; catheter C is a multilumen
(Triple-lumen); and catheter D is a through-the- needle.
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39 IV Catheter Maintenance If any of these things occur, remove
catheter and place a new one in a different location: Phlebitis
Infection Thrombosis Leaking at insertion site by itself or during
a flush Pain upon injection Any portion of the catheter is
exposed
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40 IV Catheter Maintenance If catheter site looks good, then
clean with iodophor or chlorhexidine solution Recommended not to
leave a catheter in place longer than 72 hours If bandage gets wet,
reason should be identified and bandage changed
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41 IV Catheter Maintenance If patient is chewing at bandage,
reason should be investigated Catheters not continuously used
should be flushed with 4 U/ml of heparinized saline (1000 units/
250 ml normal saline) every 4 hours Bags of heparinized saline are
discarded every 12-24 hours to minimize risk of contamination
