IV TherapyIV Therapy

NSG 1130Sinclair Community College

Peripheral IV PlacementPeripheral IV PlacementUse distal veins first

Nondominant arm

Select vein◦Easily palpated◦Feels soft and full◦Large for adequate blood flow

Avoid veins◦ Area of flexion

◦ Highly visible – tend to roll

◦ Damaged by previous use

◦ Knotted, tortuous, or bifurcation

◦ Surgically compromised or injured extremity Mastectomy Casts Decreased circulation Paralysis AV fistula

20 -22 gauge catheter

18 gauge catheter for blood transfusion

Butterfly catheter

Over the needle catheter

Secure with StatLock Cover with opsite/tedgaderm

Veins Used for CVAD Veins Used for CVAD PlacementPlacementSubclavian

Jugular

Cephalic or Basilic

SubclavianSubclavian

JugularJugular

Cephalic or Basilic veins Cephalic or Basilic veins

Central Venous Access Central Venous Access DevicesDevicesSingle lumen or Multi Lumen CVC

Peripherally inserted central catheter (PICC)

Tunneled CVC (Hickman, Groshong, & Broviac)

Implanted Infusion Ports

Single lumen or Multi Lumen Single lumen or Multi Lumen CVCCVC

Placed superior vena cava at entrance of the right atrium

Inserted by physician

Advantage◦ Administer multiple meds simultaneously without

risk of incompatibility of solutions

Disadvantages◦ High risk of complications

Pneumothorax Air embolism Infection

Peripherally inserted central Peripherally inserted central catheter (PICC)catheter (PICC)

Basilic or cephalic vein in the antecubital area

Inserted by physician or trained nurse

Threaded through axillary or subclavian vein until tip rests in the superior vena cava

Long term use, left in several months

Fewer complications of pneumothorax, air embolism, sepsis

Tunneled CVCTunneled CVC (Hickman, Groshong, & (Hickman, Groshong, &

Broviac)Broviac)Placed surgically through the deltapectoral

groove

Form a subcutaneous tunnel

Dacron cuff on the catheter is positioned between the skin incision and the vein.

The catheter is threaded into the lower part of the superior vena cava at the entrance of right atrium.

Fibrous tissue grow around the cuff and stabilized the catheter decreasing infection rate.

Long term useGroshong maintained with NS Hickman and Broviac flushed with

Heparin solution

Broviac

Hickman

Groshong

Implanted Infusion PortsImplanted Infusion PortsLong term access without catheter

protruding from skin.

Surgically inserted & sutured into a subcutaneous pocket under the skin.

Subcutaneous injection port and a Silastic catheter inserted into superior vena cava.

Self-sealing septum or port ◦ Allows repeated use without risk of air

entering the system

Located injection port by palpation

Access port with a noncorning needle (Huber point needle)

Flush with heparin solution

Noncorring Needle Noncorring Needle (Huber)(Huber)

BioPatchBioPatchProtective disk with chlorhexidine

gluconateDecrease infection risk

Complications of IV Complications of IV TherapyTherapyInfiltration

Phlebitis

Fluid Overload

Infection

Air Embolism

Speed Shock

Hourly Assessment of IV SiteHourly Assessment of IV SiteCorrect amount solution in bag

Count drip rate/ check pump rate

Check patency

Palpate vein for discomfort

Assess site for infiltration/phlebitis

Assess dressing for dry and intact

Evaluate response to therapy

Maintenance of IVMaintenance of IVChange IV bag every 24 hours

Change every q 72 hours◦Tubing◦Dressing ◦Saline lock ports ◦IV site