40088847 intravenous-therapy

INTRAVENOUS THERAPY

IV Statistics 85% of all

hospitalized patients have some type of IV therapy

118 million IV catheters inserted yearly

COMPLICATIONS

PHLEBITIS Inflammation of the vein

wall—precursor to sepsis What causes phlebitis?

IV left in too longCannula too largeVein in poor conditionAcidic solution or high

osmolality Infusion rate too fast

PreventionsChoose vein appropriately

Location

Size

Soft, spongy, resilient

No pain or tenderness or redness with injection

INFILTRATION Leaking of nonvesicant fluid into

tissues surrounding the vein

Check IV site every two hours

ComplicationsNerve compression requiring

fasciotomy

EXTRAVASATION Inadvertent administration of vesicant drug into

surrounding tissues

Calcium Magnesium Phenergan Potassium chloride Antibiotics Chemotherapy drugs Vasopressors (Dopamine, epinephrine) Dextrose > 10% Lorazepam Dilantin

INFECTION Cellulitis: An acute, spreading, bacterial

infection below the surface of the skin characterized by redness (erythema), warmth, swelling, and pain. Usually localized.

Sepsis: clinical symptoms of systemic illness, such as fever, chills, malaise, hypotension, and mental status changes. Sepsis can be life threatening.

INFECTION > 200,000 infections per year

More than 60,000 patients die annually from bloodstream infections caused by intravenous therapy

Cost for one patient is $56,000

Annual US total = $2.3 billion

Causes Poor insertion site

Squad starts

Unsterile start

IV left in too long—change q 96 hours!

Hub contamination

Cellulitis

Prevention Hand washing Sterile technique Catheter size Insertion site Site inspection every two hours Encourage patient to report any

discomfort

Patient’s Worst Nightmare!!!!

Other sites to avoid include:

• veins below a previous I.V. infiltration

• veins below a phlebitic area

• sclerosed or thrombosed veins

• areas of skin inflammation, disease, bruising, or breakdown

• an arm affected by a radical mastectomy, edema, blood clot, or infection

• an arm with an arteriovenous shunt or fistula.

Muscle Man IV!

STARTING AN IV1. Talk with patient2. Gather equipment3. Set up fluid and tubing on pump4. Check patient order and ID band &

allergies5. Wash your hands!!6. Select a vein7. Select a catheter size

8. Apply tourniquet 5-6 inches above insertion site9. Never leave tourniquet on longer than one minute10. Then Remove tourniquet and prepare equipment

STARTING AN IV (CONT.)

11. Open equipment and connect flush to J-loop

12. Loosen caps of IV and J-loop but leave in place for sterility. (They should just slide off when you pick up the device).

13. Cleanse skin with chlorhexidine gluconate solution in back & forth motion X 30 seconds

14. Allow to dry for 30 seconds

15.Put on Gloves!!!

16. Immobilize vein17. Position needle 10-15 degree angle over

site18. Insert cannula bevel up19. Watch for blood backflow20. Advance cannula21. Only try twice before calling another RN

to help

STARTING AN IV (CONT.)

Advance cannula while holding stylet stationary

Release tourniquet!!

22. Withdraw stylet while putting pressure on vein above injection site

Stabilize the hub of the canula

23. Insert tubing or prn adaptor

Apply pressure above insertion site to slow

bleeding

Stabilize the hub of the canula while inserting the tubing

Saline flush is already attached and tubing flushed and ready

It may get messy sometimes, but with experience this will be minimized

24. Flush with saline to clear tubing and insure IV has not infiltrated.

25. Stabilize tubing with tape to prevent IV from pulling out while applying the sterile dressing.

26. Apply clear sterile dressing. Cover site and hub, not tubing

Leave the end of the hub of the canula outside the dressing so that tubing can be changed without removing the dressing.

27. Date, time and initial site and tubing

STARTING AN IV (CONT.)

28. Document!

What is wrong with this picture?

Dartmouth

Power Port

CONTINUOUS INFUSION: SECURING THE NEEDLE

When starting a continuous infusion, you must secure the right-angle, non-coring needle to the skin. If the needle hub is flush with the skin, apply a transparent semipermeable dressing over the entire site. If the needle hub isn’t flush with the skin, place a folded sterile dressing under the hub, as shown. Then apply adhesive skin closures across it.

Secure the needle and tubing, using the chevron-taping technique with sterile tape.

Apply a transparent semi-permeable dressing over the entire site.

medisim@lww.com.

http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=relatedhttp://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related