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Intravenous Lines

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Aims To discussPeripheral Venous Lines• Indications• Complications

PlanningGood Clinical Practice

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Aims (Cont)Central Venous Lines• Indications• Catheter choice• Types• Complications of insertion• Problems

Golden Rules in IV TherapySummary

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Peripheral Venous Lines

80% of Hospitalised patients receive Intravenous therapy at some point during their admission.

Peripheral venous cannulation is the commonest method used for IV therapy

They are not devoid of complications leading to increased mortality and morbidity, increased hospital stay and significant costs

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Indications for Peripheral Venous Lines

Intravenous fluid administrationCorrection of electrolyte imbalanceAdministration of blood and blood productsDrug administrationProphylactic before procedures/surgeryProphylactic in unstable patients

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Complications• Local: > Position /site 44% > Phlebitis 44%

> Infiltration and Extravasation 23% > IV running too slow 42% > Patient interference 41% > IV running too fast 38%

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Complications• Systemic:Circulatory overloadPharmaceutical problemsEmbolismAllergic reactions

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Planning

Is the key to ensuring this procedure is safe and effective for the patient.

3 distinct areas to consider: > The Patient > The Equipment > The Environment

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Good Clinical PracticeObtain informed verbal consentExplain the procedure to the patientPatient allergiesANTT to reduce the risk of local and

systemic infectionsCare of lines* (RCN 2010)

Know national and local guidelines/policies

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Good Clinical PracticeUse of appropriate cleansing agent – Clinelle wipes

for hubs/access ports (Chloroprep for skin cleansing)

Regular monitoring of vital signsVIP scoreRegular monitoring of access device insertion siteDuration of access device useRemoval of access devicesDocumentation

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Central Venous Lines

A CVC is an indwelling catheter threaded into the central venous circulation; the tip will always be in either:

- Superior Vena Cava- Right Atrium - Inferior Vena Cava (femoral

approach)

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Indications for Central Venous Lines

Administration of irritant drugs/solutions and nutrition.Monitoring of CVP in acute situationsMonitoring of Cardiac outputObtaining venous access when peripheral

route fails or long term access

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Catheter choice

The type of central line used will depend upon the reason for insertion and the length of time the line is likely to stay in situ.

Preferable to use catheters with the minimum number of lumens

Use catheters impregnated with antimicrobials (with caution)

Ultrasound guided positioning (NICE 2002)

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Types of Central Venous Catheters

Short-term Venous Catheters Peripherally Inserted Central Catheters

(PICC)Tunnelled CathetersImplanted Venous Access Ports

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PICC Line

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Tunnelled catheter

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Implanted venous access ports

Port-A-cath

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Complications of insertionIncorrect positioning of catheterHaematomaHaemorrhageArterial puncturePneumothorax*Cardiac arrythmias

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Complications Perforation (R. atrium, Pulmonary artery)Local and systemic sepsis: • Colonised catheter• Exit site infection/Tunnel infection

Catheter related blood stream infection can be serious with substantial and directly attributable mortality/morbidity (10-35%)

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Complications (cont)

Damaged catheterCatheter related thrombosisSVC syndrome (Clot occlusion of blood flow in SVC)

Pinch off syndrome (rib compression of catheter)

Air emboliRemoval of catheter

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Golden Rules of IV therapy

Plan as much as possibleKnow national/local guidelines/policiesKnow how to care for venous access device

and how to remove safely.Know how to use the equipmentKnow how to prepare drugs/solutionsKnow the risks/complicationsObtain verbal informed consent whenever

possible

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Golden rules of IV therapy Use ANTTAvoid unnecessary manipulation of lines/giving

sets/pumpsLabel lines, sites clearlyRegularly examine infusions while they are

runningMonitor patients’ vital signsMaintain good documentationKnow when to seek help and from whom

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Any Questions ?

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SummaryHave discussedPeripheral Venous Lines & specific

carePlanningGood Clinical PracticeCentral Venous Lines & specific careGolden Rules in IV Therapy

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References• www.cs.cmu.edu/~pausch/news/PICCline.jpg• www.codybuker.com/.../uploads/2010/02/PICC.

gif• www.vascularphysicians.com/images/tunneled

_ca• www.ivteam.com/.../uploads/2008/08/hick.jpg• NICE (2002) Guidance on the use of ultrasound

locating devices for placing central venous catheters Guidance No 49

• RCN (2010) Standards for infusion therapy. The RCN IV Therapy Forum 3rd ed.

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