IV Initiation, Discontinuation, and Saline Locks PDF

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Summary

Taught by Beverly Lilliwhite and Suzanna Carl. Notes from lectures and powerpoints....

Description

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Initiation of PVAD o Insertion of canula into peripheral vein IV catheter size o 14 gauge – 24 gauge o Depends on admin, location, and size of vein, type of fluid to be administered and rate of admin required IV sites – veins vs arteries o Veins have valves arteries do not o veins may collapse arteries wont o Outer layer pf arteries are thicker o Arteries pulsate veins don’t o Veins are superficially located arteries lie deep. Veins o Highly distensible thin vessel walls o At any time veins carry 50% of body blood volume o Difficult to palpate when patient has significant volume loss o Have valves to keep blood from returning to heart o Difficult to advance IV catheter against a valve Assessment prior to IV start o 10 factors to consider?  Why Iv therapy is being administered  Large quantities  Viscous fluid  Hypertonic or highly irritating medications  Larger diameter veins must be chosen because  Allow rapid infusion  Reduce incidence of vascular irritability  Reduce number of restarts  Duration of therapy  Initial infusion should start distally  Alternate arms  Choose IV site proximal to last  Condition of vein  Large diameter have better blood flow and handle large amount of fluid rapidly  Avoid cord like veins, tortuous, scarred, or inflamed o Choosing a site  Arm  Dorsal  Radial  Antebrachial  Acessory cephalic  Hand  Metacarpal  Basilic  Cephalic dorsal network  Foot

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 Dorsal pedalis  Dorsal arch  Great saphenous  Location  Certain procedures may require specific sites to be used  Try to use pt non dominant hand  Select most distal site o Start in hand and work upward  Consider pt activity comfort and preference  Areas to avoid  Operative sites  Sites distal to puncture site  Flexion points  Ventral surface of wrist  Antecubital fossa  Valves  Bruised or traumatized areas  Limbs with reduced blood flow or decreased sensation  Areas below existing phlebitis  Lower extremities especially in diabetics need MD order Older adult considerations o Vessels' are more mobile fragile and tortuous and thrombosed o Dermal layer becomes thinner and less subqu tissue to support blood vessels o Veins are easier to see because of reduction of subqu tissue particularly in dorsum of hand o Meds can make tissue more frail (anticoagulants /steroids) Anticoagulant considerations o Use of tourniquets may result in bleeding o Careful technique to avoid bruising and bleeding o Tips  Apply tourniquet lightly  Avoid excessive pressure when cleaning skin  When discontinuing IV apply direct pressure over top site and slight elevation. Bleeding takes longer to stop. Remember o Use smallest gauge and shortest length catheter to achieved desired therapy o Ensure vein is larger than the catheter so  Blood flow around is sufficient to prevent irritation  There will be adequate hemodilution of solution infusing o Larger catheters will cause mechanical phlebitis sooner than smaller

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Preparing Iv site o What can increase blood flow?  Warm blanket  Below heart  Make a fist  Gravity  Hydration  tourniquet Equipment o Gather all supplies Procedure o Assemble and prepare equipment o Dilate vein o Cleanse site using concentric circles 5-7.5 cm from insertion site and allow to dry  Chlorhexidine – cleanse 30 sec  skin  Alcohol – 70% solution most common 1 min rub  items Insertion methods o Anchor vein o Bevel side up o Insert catheter at 10-30 degree angle Flashback o Once flashback is seen in chamber  Lower catheter almost parallel with skin  Advance catheter ensure not the needle  Remove tourniquet  Occlude blood flow  Apply safety feature on needle device  Connect to IV tubing or saline lock Saline lock o Covers and protects end of IV catheter. Keeps closed system reducing risk of infection o Protects staff from exposure to blood during administration changes o Provides access for intermittent IV drug therapy, blood administration and tubing changes o Can disconnect the patient from infusion for a period of time if ordered or required. Securement o Dressings are required to secure and protect o Transparent dressing is recommended o Only sterile tape is to be applied underneath transparent dressing o Loop IV tubing and tape to patients limb to prevent dislodgment Documentation o Date time of insertion  Type  Gauge

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o Location o Number of attempts o Type and flow rate of IV solution o Name and amount of medication. In solution o How pt responded to procedure o Patient education provided How many attempts o After 2 unsuccessful attempts another more experienced and qualified individual should attempt o Unsuccessful attempts must be documented o Date of insertion should clearly be written on IV site Discontinuation : saline lock the PVAD o When do you discontinue IV infusion  72 hours  Depends on policy  Pt had reaction to infusion  Allergic reaction  After dr orders  Interstitial or non-patency  Blood tinged saline is ok in saline lock unless it’s a clot. Saline flush every 12 hr o When do you discontinue a saline lock Saline heparin lock o Flushed with 2-5ml of NS prior to and following the intermittent admin of IV fluid/IV med o Must be flushed q12h when not in use to ensure patency o Sites handled with sterile technique o No dr order to flush saline lock what will you do o When is it appropriate to saline lock a pt IV infusion o CVC are flushed with diluted heparin solution after each use to keep clots from forming if non valved o Ahs uses PICCs with an internal valve and they are flushed with normal saline  Flushing normal saline is just as effective and less expensive than heparin, though heparin may still be used in some facilities. White heparin solution in locks: o Contraindicated in person with known hypersensitivity to heparin o Use with extreme caution in infants and patients with increased danger of hemorrhage.  If heparin is used then it is flushed through to pt with each infusion/ med admin...