Basic Intravenous Therapy

Intravenous (iv) therapy is the insertion of a needle or catheter/cannula into a vein, based on the physicians written prescription. The needle or catheter / cannula is attached to a sterile tubing and a fluid container to provide medication and fluids.

Purposes of IV Therapy To provide parenteral nutrition To provide avenue for dialysis/apheresis To transfuse blood products To provide avenue for hemodynamic monitoring To provide avenue for diagnostic testing To administer fluids and medications with the ability to rapidly/accurately change blood concentration levels by either continuous, intermittent or IV push method

Starting a Peripheral IV Finding a vein can be challenging Go by feel, not by sight. Good veins are bouncy to the touch, but are not always visible. Use warm compresses and allow the arm to hang dependently to fill veins. A BP cuff inflated to 10mmHg below the known systolic pressure creates the perfect tourniquet. Arterial flow continues with maximum venous constriction. If the patient is NOT allergic to latex, using a latex tourniquet may provide better venous congestion Avoid areas of joint flexion Start distally and use the shortest length/smallest gauge access device that will properly administer the prescribed therapy

IV Start Pain Management One of the most frequent contributors to patient dissatisfaction is painful phlebotomy and IV starts Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top of or just to side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine without epinephrine Topical anesthesia cream (ie EMLA) may be applied to children>37 weeks gestation 1 hr. prior to stick. It might be a good idea to anesthetize a couple of sites Have the patient close their fist (NO PUMPING) prior to stick Make sure the skin surface cleansing agent (alcohol/chlorhexidine) is dry prior to stick. Drawing this into the vein may stimulate the vasoconstrictive action of the tunica media layer

Complications of Intravenous Therapy

Infiltration/Extravasation The most common cause is damage to the wall during insertion or angle of placement STOP INFUSION and treat as indicated by Pharmacy, Medication package insert or drug reference book. Notify MD and document

Phlebitis/Thrombophlebitis Chemical - Infusate chemically erodes internal layers. Warm compresses may help while the infusate is stopped/changed. Anti-inflammatory and analgesic medications are often used no matter what the cause Mechanical - Caused by irritation to internal lumen of vein during insertion of vascular access device and usually appears shortly after insertion. The device may need to be removed and warm compresses applied Bacterial - Caused by introduction of bacteria into the vein. Remove the device immediately and treat w/antibiotics. The arm will be painful, red and warm; edema may accompany

Septicemia/Pulmonary Edema/Embolism Septicemia - Severe infection that occurs to a system or entire body - Most often caused by poor insertion technique or poor site care - Discontinue device immediately, culture and treat appropriately Pulmonary edema - caused by rapid infusion Pulmonary embolism - Caused by any free floating substances that require thrombolytic therapy for several months. Increased risk w/lower ext. Air embolism - caused by air injected into IV system. Keep insertion site below level of heart

Troubleshooting
Vascular access device will not flush/cant draw blood - Evaluate for kink in tubing or catheter tip against vein wall. Vascular access device (VAD) leaking when flushed - Verify that hub access cap is connected correctly Patient complains of pain while VAD being flushed - Assess for infiltration VAD broken - PICCs may be repaired. All other devices must be replaced