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Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous;
continuous administration is called an intravenous drip.
The word intravenous simply means “within a vein”, but is most commonly used to refer to IV therapy. Therapies administered
intravenously are often called specialty pharmaceuticals.
Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the
body.
Pre-Catheterization or Preparation
There are several factors you need to consider before initiating venipuncture:
● Type of solution to be infused. Hypertonic solutions and medications are irritating to vein.
● Condition of vein. Use soft, straight, bouncy vein; if you run your finger down the vein and it feels like a cat’s tail — avoid!
Avoid veins near previously infected areas.
● Duration of therapy. Choose a vein that can support IV therapy for 72–96 hours.
● Catheter size. Hemodilution is important. The gauge of the catheter should be as small as possible.
● Patient age. Elderly and children need additional time for assessment and management of insertion.
● Patient activity. Ambulatory patients using crutches or walker need catheter placement above the wrist.
● Presence of disease or previous surgery. Patients with vascular disease or dehydration may have limited venous access. If a
patient has a condition causing poor vascular return (mastectomy, stroke), the affected side must be avoided.
● Presence of shunts or graft. Do not use the arm or hand that has a patent graft or shunt for dialysis.
● Patient receiving anticoagulation therapy. Patients receiving anticoagulant therapy have a propensity to bleed. Local
ecchymoses and major hemorrhagic complications can be avoided if the nurse is aware of the anticoagulant therapy.
Precautions: Minimal tourniquet pressure; use the smallest catheter that is appropriate for therapy; use care in removing
dressing.
● Patient with allergies. Question regarding allergies to medications, foods, animals, and environmental substances. Identify the
allergens:
● Iodine. Avoid povidone-iodine as skin preparation
● Latex. Set up latex allergy cart
1) Needle Selection
● The smaller the gauge number, the thicker the catheter.
Catheters vary in sizes called gauges. The smaller the gauge number, the thicker the catheter and the more rapidly medicine can
be administered and blood can be drawn. Furthermore, thicker catheters cause more painful insertion, so it’s very necessary not to
use a catheter that’s larger than you need. The tip of the catheter should be inspected for integrity prior to venipuncture. Only two
attempts at venipuncture is recommended.
Recommended gauges
Size Color Recommended use
14G Orange In massive trauma situations.
16G Gray Trauma, surgeries, or multiple large-volume infusions
18G Green Blood transfusion, or large volume infusions.
20G Pink Multi-purpose IV; for medications, hydration, and routine therapies.
22G Blue Most chemo infusions; patients with small veins; elderly or pediatric patients
24G Yellow Very fragile veins; elderly or pediatric patients
3) Site Preparation
Once you’ve done your gloves, you’ll be now preparing the site of insertion.
● Apply antimicrobial solution, working from center outward in a circular motion for 2-3 inches for 20 seconds. Use enough
friction.
● Do not shave site. Shaving can cause micro abrasions; remove hair with scissors or clippers only.
● Depilatories not recommended. Potential for allergic reaction.
● Do not apply 70% isopropyl alcohol after povidone-iodine preparation. Alcohol negates the effect of povidone-iodine.
● Cleanse insertion site with one of the following solutions:
● 2% Chlorhexidine gluconate (preferred)
● Iodophor (povidone-iodine)
● 70% Isopropyl alcohol
● Tincture of iodine 2%
Post-Catheterization
1. Labeling
⮚ Insertion site
The venipuncture site should be labeled:
● Date and time
● Type and length of catheter
● Nurse’s initials
⮚ Administration set
● Label according to agency policy: label should have date on which administration set must be changed
⮚ Solution container
● Place a time strip on all parenteral solutions
● Any additives must have a clear label applied to bag
2. Equipment Disposal
● Needles and stylets shall be disposed of in non-permeable, tamper-proof containers.
● Dispose of all paper and plastic equipment in a biohazard container.
3. Patient Education
Patient must receive information on all aspects of their care. After catheter is stabilized, dressing is applied, and labeling
complete:
● Inform regarding any limitations of movement or mobility
● Explain all alarms if EID is used
● Instruct to call for assistance if venipuncture site becomes tender or sore or if redness or swelling develops
● Advise that site will be checked every shift by the nurse
4. Rate Calculation
● Ensure appropriate infusion flow.
● Do not leave patient care environment until rate is calculated and adjusted accordingly.
5. Documentation
Document the relevant data, including assessments.
● Record the start of the infusion on the client’s chart.
● Include the date and time of the venipuncture
● The gauge and length of the device
● Specific name and location of the accessed vein
● Amount of solution used, including any additives
● Container number
● Flow rate
● Type, length and gauge of the needle or catheter
● Venipuncture site, how many attempts were made and location of each attempt
● The type of dressing applied
● The client’s general response
● Your signature