IV Catheterization VTHT 1491- Special Topics Ms. Liddell

1. IV CatheterizationVTHT 1491- Special TopicsMs. Liddell CTVT: Chapter 20 (pg: 607-610) VTDRG: Chapter 8 (pg: 349-351)

2. 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

3. IV Catheterization Used for: Temporary access for medications, fluid and electrolyte replacement therapy, or transfusion of blood products

4. IV Catheterization • Catheter site selection depends on: • Available vessels • Condition of vessels • Patient • Expense • Urgency of situation

5. IV Catheterization Complications Phlebitis Local cellulitis Septicemia Collapsed veins or hematomas rendering veins unusable

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

8. 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with needle sizes • Needlepoint extends beyond catheter tip for entry into vein • Once catheter is placed, needle is withdrawn from insertion site MOST COMMON IV CATHETER USED

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over-the-needle catheters (8- to 12-inch) and are primarily used for jugular vein Once catheter is placed, needle is withdrawn from insertion site and a needle guard is placed over needle Protects needle from sticking animal and shearing catheter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=AxSCCwdN1nI

11. IV Catheter Types • Multi-lumen catheter • Have two to three separate lumens allowing simultaneous infusions at one catheter site • Placement is usually completed per- cutaneouslywith a guidewire • More expensive than other catheters Used primarily in Jugular catheterization

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

14. Peripheral Catheterization ALWAYS REMEMBER Start on the distal portion of the limb and move proximal for all catheter placement

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)

16. 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

17. Butterfly Catheter Placement http://www.youtube.com/watch?v=qsTAKiA3Uf0

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

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

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

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

25. 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

28. Peripheral Catheter Placement http://www.youtube.com/watch?v=wt_K1beUZEI http://www.youtube.com/watch?v=pUdJqaEe4Fw

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

30. Jugular IV Catheterization Hold catheter in dominant hand—other 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

34. http://www.youtube.com/watch?v=AxSCCwdN1nI

35. Multi-Lumen Catheter Placement http://www.youtube.com/watch?v=RGXP-FSjih8

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

38. 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.

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

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

41. IV Catheter Maintenance If patient is chewing atbandage, 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