Insertion: Half the Battle!. Pre-insertion checklist. Cross check your order with the IV solution Prime your tubing before getting started Check patient’s allergies IV Pole IV Supplies IV catheter of choice Double check patient’s identity- Are you sure? Ask pt for his/her name.
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Open the package per manufacturer’s recommendations. Inspect the equipment.
Slide roller clamp up close to drip chamber.
Close the roller clamp.
Remove protective cuff on fluid container.
Remove the protective cover over the piercing pin on the tubing and the bag, maintaining sterility.
After priming the tubing, close the clamp and tighten the protective cover at the end of the tubing.
Loop the tubing over the IV pole for protection and availability for use.
be removed with scissors/clippers
-explain procedure if needed
-ask how much difficulty there has been in starting IV’s
in the past
-a preferred location
Soft, straight, elastic
Supported by intact, elastic skin
Springy, easily palpated
Distal to Proximal (saves sites more proximal for future IV starts)
Alternate arms whenever possible
Avoid areas of flexion
Site should be free of trauma, abrasions or cuts
Schlerosed, thrombosed (clotted) or varicosed veins should be avoided
Clip excessive hair. You can use scissors; tape will pick up excessive hair- pain
Visualize/landmark (fingernail mark?)
Cleanse according to your institution’s Policy and Procedure
Once cleansed do not touch the site. If you palpate the vein, the skin must be cleansed again
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.
After skin prepping, apply tourniquet
Ascertain the integrity of the IV Catheter
Position in front of the limb with your dominant hand in alignment with the vein to be punctured.
Stabilize the vein by placing thumb below intended site and draw skin toward you, pulling the skin taut
Butterfly: Grasp the wings between your thumb and forefinger with the bevel facing upward. Squeeze the wings together
Over the needle: Grasp the flash back chamber and the color-coded hub with the dominant hand and remove the cover, then hold the hub and flash back chamber between thumb and forefinger. BEVEL UP!
Place the needle, bevel side up, parallel with and directly above the vein
Insert Needle At approx. 30 degree angle to the skin
After skin and vein are penetrated and a flash back of blood is observed, lower the needle to a 10 –15 degree angle and slowly advance about 3-4 millimeters farther into the vein.
This is required because the catheter is shorter than the needle; thus, backflow may occur before the catheter tip is fully in the vein
Gradually advance only the catheter, gently
Leave the stylet (needle) in place to occlude the catheter to prevent bleeding(some leaking may occur- this is normal)
Try not to place tape on occlusive dressings
Do not encircle extremity with tape
Do not allow tape to cover cannula or insertion site
What’s wrong with this picture?
Date & time
Gauge of cannula
Your initials & title
A majority of needlesticks occur to other nurses who come to help ‘clean’ up.
If it’s not noted, it was not done
Dressing begins to feel wet
Blood backs up into tubing
IV pump is beeping
Change per facility policy
Use aseptic technique
Utilize luer lock connections
Never use clamps, scissors or hemostats
Know volume capacity of add-ons
A heparin lock may consist of a catheter with tubing ending in a resealable rubber injection port, or a needless system such as a reflux valve. Many options are on the market.
Gather supplies, wash hands and don gloves
Clamp tubing to stop IV infusion.
Withdraw catheter slowly flush with the skin
Cover with 2x2 dry sterile dressing.
Raise the extremity above the heart and apply firm pressure for 1 minute
Assess catheter – CHECK THE TIP; also look for abrasions or shearing evidence
Check height of the container above the patient
Do not irrigate traumatized vessel
Assess pump function
If in doubt, pull it out.
To a bag
To a bottle
IV solutions !!!
Never infuse into an artery!- drug goes to?
Excessive manipulation of the catheter
Catheter gauge too large for the vein
Improper insertion technique (poked through?)
Inadequate stabilization of the catheter
Infusion of hypertonic or hypotonic solutions or medications
Infusion rate too rapid for the vein
pH of the solution too acid or alkaline
Compromised aseptic technique when accessing the vein or the infusion system
Improper skin preparation
Extended catheter dwell time
The infiltration of blood into the tissues. A hematoma occurs if the bleeding is uncontrolled at the venipuncture site, creating a hard lump
Identified as a swelling above the IV site; bruising may be immediate or slow
Apply firm pressure to the IV site
Elevate the extremity
Do no use the affected extremity until bleeding has completely stopped
Do not reapply a tourniquet to the affected extremity until bleeding has completely stopped
Apply firm pressure to prevent bleeding into subcutaneous tissue when catheter removed
The inadvertent administration of a non-vesicant solution or medication into surrounding tissues
Edema at the insertion site
Skin may appear taut or stretched
Blanching or coolness of the skin
Infusion may be sluggish or stopped
Tenderness at the site
The inadvertent administration of a vesicant (highly irritating/destructive) solution or medication into surrounding tissues (phenergan, some abx, others)
Improper selection of the catheter or site—catheter gauge too large, or small thin-walled veins
IV catheter inadequately secured
IV site is over a joint
Inappropriate route or rate of administration for the solution/medication
Stop the infusion and remove the catheter
Elevate the extremity to improve circulation and absorb the fluid
Initiate a new infusion in the opposite extremity, if indicated
Same as Infiltration PLUS:
-an agent capable of causing or forming a
blister or causing tissue destruction
Attempt flush with 10 mL SYRINGE only!
Remove peripheral catheter, restart in another vein
Alteplase for Central Line Catheters
The laws of physics dictate that given equal force on two syringes, that a small-cylinder syringe (like a 2-3 ml) will exert more pressure than a larger syringe (like a 10 ml) for IV lines, and for the patient’s vein. The high pressure may “blow” the patient’s vein, as in tear it, creating extravasation/bleed.
“Larger syringes create less pressure when used to withdraw and/or flush”
Macklin D. “What's physics got to do with it” JVAD. Summer 1999
Hands of medical personnel
Insertion site contamination
Another site of infection, i.e., GI or Urinary tract infection
Remove dressing securing site, thoroughly cleanse site with 70% alcohol, air dry.
Remove the cannula without touching it or dragging it on the client’s skin
After the cannula has been removed, clip approximately ½-1 inch of catheter with sterile scissor, drop into a sterile specimen cup