Show
The ability to obtain intravenous (IV) access is an essential skill in medicine and is performed in a variety of settings by paramedics, nurses and physicians. Although the procedure can appear deceptively simple when performed by an expert, it is in fact a difficult skill which requires considerable practice to perfect. The rate of fluid flow is proportional to radius to the power of four, and inversely proportional to length; therefore fluids run fastest through a shorter and larger diameter tube. Also note that the smaller the gauge of a needle, the larger its diameter i.e. a 14 gauge needle has larger diameter than a 21 gauge needle. Indications By starting a peripheral IV, you gain access to the peripheral circulation of a patient, which will enable you to sample blood as well as infuse fluids and IV medications. IV access is essential to manage problems in all critically ill patients. High volume fluid resuscitation may be required for the trauma patient, in which case at least two large bore (14-16 G) IV catheters are usually inserted. All critically ill patients require IV access in anticipation of future potential problems, when fluid and/or medication resuscitation may be necessary. Contraindications Some patients have anatomy that poses a risk for fluid extravasation or inadequate flow and peripheral IVs should be avoided in these situations. Examples include extremities that have massive edema, burns or injury; in these cases other IV sites need to be accessed. For the patient with severe abdominal trauma, it is preferable to start the IV in an upper extremity because of the potential for injury to vessels between the lower extremities and the heart. For the patient with cellulitis of an extremity, the area of infection should be avoided when starting an IV because of the risk of inoculating the circulation with bacteria. As well, an extremity with an indwelling fistula or on the same side of a mastectomy (occasionally a problem) should be avoided because of concerns about adequate vascular flow. Complications The main complications of an IV catheter are infection at the site and development of superficial thrombophlebitis in the vein that is catheterized. It is also common for the IV sites to leak interstitially. Universal precautions The potential for contact with a patient's blood
while starting an IV is high and increases with the inexperience of the operator. Gloves must be worn while starting an IV and if the risk of blood splatter is high, such as an agitated patient, the operator should consider face and eye protection as well as a gown. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns. As well, once removed from the protective sheath, IV catheters should either go into the patient or into an appropriate sharps container.
Peripheral IV sites Generally IV's are started at the most peripheral site that is available and appropriate for the situation. This allows cannulation of a more proximal site if your initial attempt fails. If you puncture a proximal vein first, and then try to start an IV distal to that site, the fluid may leak from the injured proximal vessel. The preferred site in the emergency department is the veins of the forearm, followed by the median cubital vein that crosses the antecubital fossa. In trauma patients, it is common to go directly to the median cubital vein as the first choice because it will accommodate a large bore IV and it is generally easy to catheterize. In circumstances where the veins of the upper extremities are inaccessible, the veins of the dorsum of the foot or the saphenous vein of the lower leg can be used. In circumstances in which no peripheral IV access is possible a central IV can be started. Equipment All necessary equipment should be prepared, assembled and available at the bedside prior to starting the IV. Basic equipment includes:
To prepare the IV line, protective caps are removed from the fluid bag and the spiked end of the IV tubing. The regulating clamp for the IV line should be closed. The spiked end of the IV tubing is inserted into the receptacle on the IV bag while holding the IV bag inverted. The bag is then held upright with the IV line hanging from the bottom. The drip chamber should be filled half-way by pinching it and releasing. Following this the bag should be hung for the IV pole, at a point above the patient, and the regulating clamp should be opened to "flush" the line of air bubbles prior to connection to the patient. Establishing a peripheral intravenous line
To remove the IV
What is the most important reason for starting intravenous infusions in the upper extremities?For the patient with severe abdominal trauma, it is preferable to start the IV in an upper extremity because of the potential for injury to vessels between the lower extremities and the heart.
What is the most important reason for starting intravenous infusions in the upper extremities rather than the lower extremities of adults quizlet?Venous return is usually better in the upper extremities. Cannulation of the veins in the lower extremities increases the risk of thrombus formation (B) which, if dislodged, could be life-threatening.
What action is most important for the nurse to implement when donning sterile gloves?which action is most important for the nurse to implement when donning sterile gloves? keep gloved hands above the elbows. Gloved hands held below waist level are considered unsterile. A client who is in hospice care complains of increasing amounts of pain.
When administering an IV antibiotic to a client where would the nurse hang the piggyback container?9. Ensure piggyback mini bag is hung above the primary IV solution bag. Position of the IV solutions influences the flow of the IV fluid into the patient. The setup is the same if the medication is given by gravity or through an IV infusion pump.
|