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Peripheral IV insertion. Scott and White. Indications for IV Therapy. Establish or maintain a fluid or electrolyte balance Administer continuous or intermittent medication Administer bolus medication Administer fluid to keep vein open (KVO) Administer blood or blood components. - PowerPoint PPT Presentation
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Peripheral IV insertion
Scott and White
Indications for IV Therapy
Establish or maintain a fluid or electrolyte balance
Administer continuous or intermittent medication
Administer bolus medication Administer fluid to keep vein open (KVO) Administer blood or blood components
Indications for IV Therapy
Administer intravenous anesthetics Maintain or correct a patient's nutritional
state Administer diagnostic reagents Monitor hemodynamic functions
Procedures
Gather supplies IV cannula IV tubing IV fluid or Heparin lock
Steel Needles
Butterfly catheter. They are named after the wing-like plastic tabs at the base of the needle. They are used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples (although not routinely, since the small diameter may damage blood cells). These are small gauge needles (i.e. 23 gauge).
Steel Needles
Over the Needle Catheter
Gauges
Catheters (and needles) are sized by their diameter, which is called the gauge. The smaller the diameter, the larger the gauge. Therefore, a 22-gauge catheter is smaller than a 14-gauge catheter.
To deliver large amounts of fluid or viscous solutions such as blood and blood components, you should select a large vein and use a 20 gauge or less.
To administer medications, an 20 –22 gauge or in a smaller vein will do. The smaller the catheter, the less the irritation to the vein.
Gauges
Approach to Patient
Introduce yourself to the patient Assess the patient identification Assess alertness and attitude of patient Explain to the patient and/or family the need
for the procedure Explain to the patient and/or family the steps
in the procedure
Methods
Raise the bed/ gurney sufficiently high that you can work in good light without hurting your back.
If the intended site is distal, kneel or seat yourself so that you can work closely and steadily.
Vein Selection
Veins of the hand1. Digital Dorsal Veins2. Dorsal Metacarpal Veins3. Dorsal Venous Network4. Cephalic Vein5. Basilic Veins
Vein Selection
1. Cephalic Vein2. Median Cubital Vein3. Accessory Cephalic Vein4. Basilic Vein5. Cephalic Vein6. Median Antebrachial Vein
Vein Selection
Try to cannulate the most distal veins first. If for example, the antecubital veins are ruined
as a result of failed cannulation attempts, this can cause problems in the event of a successful cannulation further down.
Any drugs or fluids put through the cannula may extravasate at the failed cannula site
Inappropriate sites
Edematous areas Hematomas Scarred areas Arms with cannulas, fistulas or vascular
grafts
Universal Precautions
If the IV cannot be started with gloves on, ---it cannot and should not be started.
Protect yourself with adequate body-substance isolation at all times.
Glasses, goggles, or splash shields, may also be worn.
ALL patients must be considered infective at all times. It is NOT ACCEPTABLE to compromise precautions for any reason [this includes tearing off a finger tip of one's glove to permit palpation].
Methods
Occlude Venous Flow Apply tourniquet 4-6 inches above the
insertion site. Veins may also be distended by placing the limb in a dependent position, applying a warm pack in addition to the tourniquet, or applying a blood pressure cuff. The tourniquet or blood pressure cuff should not obstruct arterial flow.
Apply Tourniquet
Methods
Prep The Skin Alcohol Scrub
Use vigorous circular motion. Allow the skin to dry. This procedure defats the skin.
Clean with alcohol
Methods
Povidone Iodine Scrub Using a circular motion, work from the
center of the insertion site outwards. Allow to dry for two minutes. If the patient is allergic to iodine preparations
use a vigorous two minute alcohol scrub.
Venipuncture
Hold the skin taut and anchor the vein with the thumb of your free hand. Avoid recontamination of the area.
Lower the hub of the needle close to the skin and align needle for insertion.
Insert the needle, bevel up, into the skin and subsequently into the vein. The free hand is used to stabilize the vein while the needle is being introduced. If the needle is in the vein, blood return will be visible in the flashback chamber.
Venipuncture
Venipuncture-Side
Technique for skin puncture at the side of the selected vein.
The needle should puncture the skin to one side of the vein about 1/2 to one inch below where the needle will enter the vein. Pierce the skin at a 45 angle along side of the vein. Once through the skin, insert the needle into the vein nearly parallel to the vessel (10-20 angle).
Venipuncture-Over
Technique for skin puncture directly over the selected vein.
The needle should puncture the skin at a 45 angle directly over the selected vein. Once through the skin, decrease the angle to about 10-20 and enter the vein.
Methods
After the needle has entered the vein, proceed to slowly advance the needle approximately 1/2 inch.
Carefully withdraw the needle about 1/2 inch while continuing to advance the catheter.
Inserting cannula
Method
Apply pressure to the vein just above the tip of the catheter to obstruct blood flow.
Remove the introducer needle. Connect the catheter to IV tubing or to “heparin” lock.
Method
Release the tourniquet Cover the insertion site with a transparent
occlusive dressing, tape securely,label. Begin IV fluid or flush “Heparin” lock Remember that IV catheter site rotation is
recommended every 72 hours, unless you are using extended dwell catheters.
Remove tourniquet
Unsuccessful
If you are unsuccessful in entering the vein and there is no flashback, then slowly withdraw the catheter, without pulling all the way out, and carefully watch for the flashback to occur
Unsuccessful
If you are still not within the vein, then advance it again in a 2nd attempt to enter the vein. While withdrawing always stop before pulling all the way out to avoid repeating the painful initial skin puncture.
Unsuccessful
If after several manipulations the vein is not entered, then release the tourniquet, place a gauze over the skin puncture site, withdraw the catheter and tape down the gauze. Try again at another site.