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 long
 Cannula too large
 Vein in poor condition
 Acidic solution or high
osmolality
 Infusion rate too fast
 Preventions
Choose 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

 Complications
 Nerve 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 IV
 Talk with patient
 Gather equipment
 Set up fluid and tubing on pump
 Check patient order and ID band &
allergies
 Wash your hands!!
 Select a vein
 Select a catheter size
1. Apply tourniquet 5-6 inches above insertion site
2. Never leave tourniquet on longer than one minute
3. Then Remove tourniquet and prepare equipment
 STARTING AN IV (CONT.)
 Open equipment and connect flush to J-
loop
 Loosen caps of IV and J-loop but leave in
place for sterility. (They should just slide off when
you pick up the device).
 Cleanse skin with chlorhexidine gluconate
solution in back & forth motion X 30
seconds
 Allow to dry for 30 seconds
1. Put on Gloves!!!
 STARTING AN IV (CONT.)
 Immobilize vein
 Position needle 10-15 degree angle over
site
 Insert cannula bevel up
 Watch for blood backflow
 Advance cannula
 Only try twice before calling another RN
to help
Advance cannula while holding stylet
stationary
Release tourniquet!!
 Stabilize the hub of the canula

22. Withdraw stylet while putting pressure on

vein above injection site
 Stabilize the hub of the canula
Apply pressure above while inserting the tubing
insertion site to slow
bleeding

Saline flush is already attached and

tubing flushed and ready

23. Insert tubing or prn adaptor

It may get messy sometimes, but with experience
this will be minimized
• Flush with saline to clear tubing and insure IV has not infiltrated.
3. Stabilize tubing with tape to prevent IV from pulling out while
applying the sterile dressing.
Leave the end of the hub
of the canula outside the
dressing so that tubing
can be changed without
removing the dressing.

1. Apply clear sterile dressing. Cover site and hub, not tubing
27. Date, time and initial site and tubing
 STARTING AN IV (CONT.)

3. 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.
http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=related
http://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related

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

medisim@lww.com.