Professional Documents
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Sds
Sds
Therapy
90-95% of patients in the
hospital receive some type
of intravenous therapy.
Vein Anatomy
- Tunica Adventitia
- Tunica Media
- Tunica Intima
- Valves
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Tunica Adventitia
the outer layer of the vessel
Connective tissue
Contains the
arteries and veins
supplying blood to
vessel wall
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Tunica Media
the middle layer of the vessel
Contains nerve
endings and muscle
fibers
The vasoconstrictive
response occurs at
this layer
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Tunica Intima
the inner layer of the vessel
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Valves
present in MOST veins
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Veins of the Upper Extremities
Digital Vessels
-Along lateral aspects fingers, infiltrate
easily, painful, difficult to immobilize and
should be your LAST RESORT
Metacarpal Vessels
-Located between joints and Digital
metacarpal bones (act as natural splint)
-Formed by union of digital veins
-Geriatric patients often lack enough
connective / adipose tissue and skin
turgor to use this area successfully
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Veins of the Upper Extremities
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Veins of the Upper Extremities
Basilic
- Originates from the ulner side of
the metacarpal veins and runs
along the medial aspect of the arm.
It is often overlooked becauses of
its location on the “back” of the
arm, but flexing the elbow/bending
the arm brings this vein into view
Medial Basilic
- Empties into the Basilic vein
running parallel to tendons, so it is
not always well defined. Accepts
larger gauge catheters.
- BEWARE of Brachial Artery/Nerve
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Purposes of IV Therapy
To provide parenteral nutrition
To provide avenue for dialysis/apheresis
To transfuse blood products
To provide avenue for hemodynamic monitoring
To provide avenue for diagnostic testing
To administer fluids and medications with the ability to rapidly/accurately
change blood concentration levels by either continuous, intermittent or IV
push method.
Types of Peripheral Venous Access Devices
•Butterfly(winged) or Scalp vein needles (SVN) – not recommended for non compliant
patient as it can easily penetrate the vein wall causing extravasation. We use these
frequently for phlebotomy
•Safety Over the needle catheters (ONC)
- PROTECTIV ® -ACUVANCE ®
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Starting a Peripheral IV
Finding a vein can be challenging
- Go by “feel”, not by sight. Good veins are bouncy to the touch, but are
not always visible.
- Use warm compresses and allow the arm to hang dependently to fill
veins.
- A BP cuff inflated to 10mmHg below the known systolic pressure creates
the perfect tourniquet. Arterial flow continues with maximum venous
constriction.
- If the patient is NOT allergic to latex, using a latex tourniquet may
provide better venous congestion
- Avoid areas of joint flexion
- Start distally and use the shortest length/smallest gauge access device
that will properly administer the prescribed therapy
(BE AWARE: Blood flow in the lower forearm and hand is 95ml/min)
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IV Start Pain Management
One of the most frequent contributors to patient dissatisfaction is
painful phlebotomy and IV starts
• Use 25-27g insulin syringe to create a wheal similar to a TB skin test on top
of or just to side of vein with 0.1 -0.2 ml normal saline or 1% xylocaine
without epinephrine
• Have the patient close their fist (NO PUMPING) prior to stick
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Flushing Peripheral IV’s
Use prefilled saline and heparin flush syringes located in PYXIS
Heparin flush concentrations available:
-100u/ml (5ml in a 10ml syringe)
-10u/ml (2ml in a 3ml syringe)
- Adults: q 8hrs
w/1ml. 0.9%NS [3ml heparinized saline for OB]
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Dressing/Bag Changes
Physician orders are
required if a peripheral
catheter is left in the same
site for more than 3 days.
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Central Venous Catheters
Percutaneous Tunneled PICC’s Implanted Ports Dialysis
Insertion MD @ bedside w/x- MD in OR under MD/trained RN @bedside MD in OR under fluoroscopy MD in OR under
ray confirmation fluoroscopy w/x-ray confirmation fluoroscopy
Location Visible externally. Visible ext. usually Visible externally around Completely internal. Titanium or plastc Visible externally.
Enters subclavian, midway bet. clavicle antecubital fossa, upper port is implanted in a surgically created Arm or leg
ext. juglar,or int. and nipple. Tunneled arm or neck pocket and catheter is threaded into placement
juglar vein near under skin & subclavian or int. juglar vein. Access is
clavicular area threaded through through skin into self sealing port using
subclavian or IJ special non coring needle
Material/Cost Polyurethane Silicone Silicone / polyurethane Silicone catheter. Port is titanium or Various materials
$200-$400 $3500-$5000 $350-$500 plastic w/self sealing diaphragm
$3500-$5000
Lumen 2-3 2-3 1-2 1-2 2-3
Sutured Yes/entire life Yes, until internal No Yes Yes
Dacron cuff healed
Duration Short term 4-10 Long term Long term Long term Mid term
days
Flushes 5-10ml NaCl after 5-10ml NaCl after 5-10ml NaCl after use and 10ml NaCl followed by 4.5ml Done ONLY by IV
use and daily use and daily daily heparinized saline (adults-100units/ml; team or dialysis
peds-10units/ml) after ea. use or nurses
monthly if not accessed
Brands/ Arrow Howe, Triple Hickman, Broviac PICC, PIC, EDPC, Arrow Bard, Accces Port-A-Cath Bard, Tesio,
Names Lumen, Subclavian, Howe, Gesco, PASV Vescath, Quinton
IJ
Discontinue MD or speically MD in OR Specially trained RN @ MD in OR MD in OR
trained RN @ bedside
bedside
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Central Venous Catheter Sites
Percutaneous(Subclavian)
PICC (Peripherally inserted
Central Catheter)
Implanted Port
(single or double
lumen)
Percutaneous Tunneled
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CVC Care/Maintenance
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Infiltration/Extravasation
The most common cause is damage to the
wall during insertion or angle of placement.
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Phlebitis/Thrombophlebitis
Chemical
- Infusate chemically erodes
internal layers. Warm compresses may
help while the infusate is
stopped/changed. Anti-inflammatory
and analgesic medications are often
used no matter what the cause
Mechanical Bacterial
- Caused by irritation to - Caused by introduction of
internal lumen of vein during insertion bacteria into the vein. Remove the
of vascular access device and usually device immediately and treat
appears shortly after insertion. The w/antibiotics. The arm will be
device may need to be removed and painful, red and warm; edema may
warm compresses applied accompany
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Cellulitis
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Septicemia/Pulmonary Edema/
Embolism
Septicemia
- Severe infection that occurs to a system or entire body
- Most often caused by poor insertion technique or poor site care
- Discontinue device immediately, culture and treat appropriately
Air embolism- caused by air injected into IV system. Keep insertion site
below level of heart
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Troubleshooting
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Policy notes
KVO rate:
RN’s and LPN’s can start Adults - 10 ml/hr Only until rate
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IV Medication Administration
Many medications require patient All Medications Cannot Be
monitoring that cannot be done on Administered on All Units
units where the nurse/patient General Care Units: Can give meds
requiring only basic physical
ratios are greater than 1:2 assessment data
Stepdown Units: Can give meds
that require more invasive or
frequent monitoring than is available
on general care units
A patient can be moved to a unit
Intensive Care Units: Can give
where the ratio is appropriate for meds that require more invasive or
invasive/frequent monitoring or frequent monitoring than is available
on the Stepdown units.
another nurse can be brought to
care for the patient during the med VANDERBILT URL LINK FOR IV
administration MEDICATIONS:
www.mc.vanderbilt.edu/pharmacy/ivroom/IV
MedAdm061003.pdf
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IV Medication Administration
Sample page
from the
Pharmacy med
administration
web site
See “APPROVED
FOR” section.
You will find if
the medication
can be
administered on
your unit.
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www.ins1.org
Infusion Nurses Society (INS)
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