copyright © 2006 by mosby, inc. all rights reserved. chapter 11 intravenous cannulation
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Copyright © 2006 by Mosby, Inc. All rights reserved.
Chapter 11Chapter 11Intravenous CannulationIntravenous Cannulation
Copyright © 2006 by Mosby, Inc. All rights reserved.
ObjectivesObjectives
Define the term Define the term intravenous cannulationintravenous cannulation
Recall the indications and contraindications of Recall the indications and contraindications of intravenous cannulationintravenous cannulation
Identify the equipment used to perform intravenous Identify the equipment used to perform intravenous cannulationcannulation
Select preferred solutions for use in management of Select preferred solutions for use in management of trauma and medical emergenciestrauma and medical emergencies
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ObjectivesObjectives
Recall the recommended ratio of IV replacement to Recall the recommended ratio of IV replacement to blood loss in patients experiencing hypovolemic blood loss in patients experiencing hypovolemic shockshock
Describe the methods used to determine the proper Describe the methods used to determine the proper IV flow rateIV flow rate
List the advantages, disadvantages, and List the advantages, disadvantages, and complications associated with the use of peripheral complications associated with the use of peripheral veinsveins
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ObjectivesObjectives
Identify the veins that are commonly used for Identify the veins that are commonly used for peripheral intravenous cannulationperipheral intravenous cannulation
Recall the steps used to perform peripheral Recall the steps used to perform peripheral intravenous cannulationintravenous cannulation
Use problem-solving skills with IV lifelines that are not Use problem-solving skills with IV lifelines that are not functioning properly to determine the cause and functioning properly to determine the cause and correct the problemcorrect the problem
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ObjectivesObjectives
List complications associated with IV therapyList complications associated with IV therapy
Demonstrate the steps for discontinuing an IV Demonstrate the steps for discontinuing an IV lifelinelifeline
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IntroductionIntroduction
Intravenous cannulationIntravenous cannulation Placement of a catheter in a veinPlacement of a catheter in a vein Administer blood, fluids, medicationsAdminister blood, fluids, medications Obtain blood specimensObtain blood specimens
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IntroductionIntroduction
Intravenous cannulationIntravenous cannulation IndicationsIndications
• Cardiac diseaseCardiac disease• HypoglycemiaHypoglycemia• SeizuresSeizures• Shock Shock • Precautionary measurePrecautionary measure
ContraindicationsContraindications• Sclerotic veinsSclerotic veins• Burned extremitiesBurned extremities• Critical patientsCritical patients
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Body Substance Isolation PrecautionsBody Substance Isolation Precautions
When performing IV therapyWhen performing IV therapy
Hepatitis B virus (HBV)Hepatitis B virus (HBV)
Human immunodeficiency virus (HIV)Human immunodeficiency virus (HIV)
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Body Substance Isolation PrecautionsBody Substance Isolation Precautions
GlovesGloves
Barrier protectionsBarrier protections
Proper disposalProper disposal
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IV CannulationIV Cannulation——EquipmentEquipment
IV solutionIV solution Administration setAdministration set Extension setExtension set Needles/cathetersNeedles/catheters TourniquetTourniquet Protective glovesProtective gloves Gown and gogglesGown and goggles
TapeTape Antibiotic swabs/ointmentAntibiotic swabs/ointment Gauze dressingsGauze dressings 10ml-35mL syringes10ml-35mL syringes Vacutainer holderVacutainer holder Assorted blood collection Assorted blood collection
tubestubes Padded arm boardsPadded arm boards
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EquipmentEquipment
Intravenous solutionsIntravenous solutions 25 – 1000 mL25 – 1000 mL Clear plastic bagClear plastic bag Two portsTwo ports
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EquipmentEquipment
Colloids and crystalloidsColloids and crystalloids Normal saline and Normal saline and
lactated Ringer’slactated Ringer’s 3 L IV crystalloid/1 L 3 L IV crystalloid/1 L
blood lost (3:1)blood lost (3:1)
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EquipmentEquipment
Administration setAdministration set Piercing spikePiercing spike Drip chamberDrip chamber Flow clampFlow clamp Drug administration portDrug administration port Connector endConnector end
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EquipmentEquipment
Microdrip chamberMicrodrip chamber Precise amountsPrecise amounts
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EquipmentEquipment
Macrodrip chamberMacrodrip chamber Large amountsLarge amounts
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EquipmentEquipment
IV flow ratesIV flow rates Medical emergenciesMedical emergencies
• ““To keep open” (TKO)To keep open” (TKO)
• Precautionary measurePrecautionary measure
• Administer medicationsAdminister medications
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EquipmentEquipment
IV flow ratesIV flow rates Trauma Trauma
• Patient’s responsePatient’s response PulsePulse B/PB/P Capillary refill <6 y/oCapillary refill <6 y/o Cerebral functionCerebral function
• Severe hypovolemic patientSevere hypovolemic patient
• Wide open rateWide open rate
• 2-3 L limit2-3 L limit
• 3-4 times normal flow3-4 times normal flow
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EquipmentEquipment
Volutrol chamber Volutrol chamber Specific amountsSpecific amounts Pediatric infusionsPediatric infusions
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EquipmentEquipment
Over-the-needle catheterOver-the-needle catheter Through-the-needle catheterThrough-the-needle catheter
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EquipmentEquipment
Hollow needle (butterfly Hollow needle (butterfly type)type)
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EquipmentEquipment
IV catheter with attached syringeIV catheter with attached syringe
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Differences Between Arteries and VeinsDifferences Between Arteries and Veins
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Sites for Peripheral Venous CannulationSites for Peripheral Venous Cannulation
Sites used in routine Sites used in routine situationssituations
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Sites for Peripheral Venous CannulationSites for Peripheral Venous Cannulation——Other SitesOther Sites
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Procedure for PerformingProcedure for PerformingIV CannulationIV Cannulation
Insert spiked piercing Insert spiked piercing into IV baginto IV bag
Drip chamber filled to Drip chamber filled to half wayhalf way
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Place tourniquetPlace tourniquet
Make slip knotMake slip knot
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Complete band placementComplete band placement
Cleanse siteCleanse site
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Pull skin tautPull skin taut——needle needle bevel facing upbevel facing up
Penetrate at juncturePenetrate at juncture
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Enter vein from either top Enter vein from either top or sideor side
Watch for blood flashbackWatch for blood flashback
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Advance needleAdvance needle
Slide catheterSlide catheter
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Remove needleRemove needle
Draw blood sampleDraw blood sample
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Release tourniquetRelease tourniquet
Connect IVConnect IV
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Secure in placeSecure in place
Commercial deviceCommercial device
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Proper disposal of used Proper disposal of used needleneedle
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Documentation Documentation Date/time Date/time Type/amountType/amount Device usedDevice used SiteSite Number of attemptsNumber of attempts Flow rateFlow rate Adverse reactionsAdverse reactions Name of EMT-IName of EMT-I
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
Common puncture sites that use an arm boardCommon puncture sites that use an arm board
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Procedure for Performing Procedure for Performing IV CannulationIV Cannulation
ComplicationsComplications PainPain Catheter shearCatheter shear Circulatory overloadCirculatory overload Cannulation of an arteryCannulation of an artery Hematoma or infiltrationHematoma or infiltration Local infectionLocal infection Air embolismAir embolism Pyrogenic reactionPyrogenic reaction
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Discontinuing the IV LifelineDiscontinuing the IV Lifeline
EquipmentEquipment Protective glovesProtective gloves Sterile gauze padsSterile gauze pads Adhesive bandageAdhesive bandage
Close control valveClose control valve
Carefully untape and remove dressingCarefully untape and remove dressing
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Discontinuing the IV LifelineDiscontinuing the IV Lifeline
Stabilize tissue with dressingStabilize tissue with dressing
Withdraw catheterWithdraw catheter
Cover puncture site with dressing and tapeCover puncture site with dressing and tape
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External Jugular Vein CannulationExternal Jugular Vein Cannulation
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SummarySummary
IV cannulation is used for administering IV cannulation is used for administering blood, fluids, or medications into circulatory blood, fluids, or medications into circulatory system and for obtaining blood samplessystem and for obtaining blood samples
IV placement should never delay patient IV placement should never delay patient transporttransport
Normal saline and lactated Ringer's solution Normal saline and lactated Ringer's solution are recommended for prehospital therapy; are recommended for prehospital therapy; they are isotonic crystalloid solutionsthey are isotonic crystalloid solutions
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SummarySummary
Crystalloid solutions diffuse out of circulatory system Crystalloid solutions diffuse out of circulatory system quickly; at least 3 L must be administered for every quickly; at least 3 L must be administered for every liter of blood lostliter of blood lost
Two most common administration sets are micro Two most common administration sets are micro (delivers 60 drops/mL) and macro (delivers 10 to 20 (delivers 60 drops/mL) and macro (delivers 10 to 20 drops/mL)drops/mL)
Plastic over-the-needle catheters are most commonly Plastic over-the-needle catheters are most commonly used because they can be better anchored and used because they can be better anchored and permit freer patient movementpermit freer patient movement
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SummarySummary
In noncritical patients, use distal veins on dorsal In noncritical patients, use distal veins on dorsal aspect of hand as IV sitesaspect of hand as IV sites
During cardiac arrest, preferred sites are veins of During cardiac arrest, preferred sites are veins of antecubital fossaantecubital fossa
Difficult cannulation can occur in obese persons, Difficult cannulation can occur in obese persons, during shock and cardiac arrest, in chronic mainline during shock and cardiac arrest, in chronic mainline drug users, in elderly patients with "fragile" or "rolling drug users, in elderly patients with "fragile" or "rolling veins," and in small childrenveins," and in small children
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SummarySummary
When selecting equipment for IV therapy, ensure When selecting equipment for IV therapy, ensure fluid is clear, not outdated, and bag has no leaksfluid is clear, not outdated, and bag has no leaks
Employ infection control procedures when Employ infection control procedures when assembling administration set, cannulating vein, and assembling administration set, cannulating vein, and attaching IV tubing to catheterattaching IV tubing to catheter
Discard needles appropriatelyDiscard needles appropriately
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SummarySummary
Release tourniquet once IV is connected to catheterRelease tourniquet once IV is connected to catheter
Carefully monitor patient for signs of improvement Carefully monitor patient for signs of improvement and for signs of circulatory overloadand for signs of circulatory overload
Some complications of IV therapy are pain, catheter Some complications of IV therapy are pain, catheter shear, circulatory overload, cannulation of artery, shear, circulatory overload, cannulation of artery, infiltration/hematoma, local infection, and air infiltration/hematoma, local infection, and air embolismembolism