Download IV Notes from Campus Lab Video 3rd Semester

WEST VIRGINIA
NORTHERN
COMMUNITY
COLLEGE
CAMPUS LAB DAY
FALL 2013
(Notes from DVD)
Site Selection
Site selection depends on the following criteria:
1. Physical Assessment
 Depends on patients condition, age, diagnosis, and activity level
2. Infusion Prescription Therapy
 Depends on the type and duration of prescribed infusion therapy
3. Peripheral Vascular Availability
 Depends of the condition, size, and location of the vein
Veins
Sites include, but not limited to:
1. Dorsal Metacarpals & Carpals of the hand
2. Cephalic
3. Basilic
4. Median Cubital
5. Median Antebrachial
6. Internal jugular, subclavian, median basilic, median cephalic, cephalic, basilic,
axillary,
brachiocephalic and superior vena cava (sites utilized for central venous access
devices [CVAD’s]).
Less than 2 years of age, sites may include the external jugular, axillary, long and
short saphenous, temporal, frontal (metopic) vein, superficial temporal vein,
occipital vein, and posterior auricular vein.
IV Considerations
1. Peripheral lines are changed every 72 hours.
2. When placing an IV, avoid areas of flexion.
3. Infusion prescriptions with extreme variations or ranges in osmolarity & pH
may require a CVAD.
4. The selected catheter should fit the needs of the patient.
5. Select the shortest & smallest catheter required to enhance blood flow around
the catheter.
IV complications
1. Air Embolism
 May exhibit symptoms such as chest pain, SOB, shoulder pain, lower back
pain, anxiety,
hypotension, weak-rapid pulse, & loss of consciousness.
 Loud churning noise heard over the precordium (part of chest wall that lies
over the heart).
 May lead to death in some circumstances.
2. Catheter Embolism
 Occurs when a fragment of the catheter travels through the blood stream
and blocks the heart and lungs.
 Will lead to cardiac dysrhythmias and cardiac arrest.
 Occurs due to poor insertion technique.
3. Fluid Overload & Pulmonary Edema
 Occur due to the presence of excess fluid volume related to an increased
infusion rate or too much volume given within a given time period.
 May lead to congestive heart failure (CHF), shock, and cardiac arrest.
 Those most susceptible are neonates, pediatrics, renal and cardiac patients,
and the elderly.
 Exhibited signs and symptoms include: SOB, cough, elevated pulse,
dyspnea, moist respirations, frothy sputum, enlarged neck veins (JVD), and
periorbital edema.
4. Speed Shock
 This is a systemic reaction that occurs when a substance is rapidly infused.
 Signs and symptoms may include facial flushing, dizziness, and headache.
 You should stop the infusion process or slow the rate.
5. Septicemia
 Occurs when pathogens enter into circulation of the blood stream.
 Hand hygiene is of upmost importance.
 Infusion system contamination may occur related to contamination of the
container, administration set, and ad-on’s such as stopcocks, access ports,
extension sets, and catheter materials.
 Contamination may also occur to the following; catheter materials, the
dwell of the catheter technique, site selection, manipulation of the delivery
system, dressing materials, and application procedures.
Nursing Interventions
1. Bruising
 Utilizing a skilled-insertion technique.
 Applying the tourniquet only for a brief period of time.
 Utilize firm, yet gentle pressure to achieve hemostasis after catheter
removal.
 Assess site frequently.
 Change site every 72 hours and as needed.
 Document assessment in patient’s permanent medical record (PMR).
2. Extravasations
 This is the escape of fluid (blood, serum, or lymph, or drugs) into the
tissues.
 You should discontinue the infusion immediately once noted.
 Elevate the extremity per patient comfort.
 Provide adequate catheter stabilization at time of device insertion.
 Assess catheter-skin related area frequently to detect any early signs of
complication development.
 Only qualified nurses should administer vesicant (drug that can cause
necrosis of tissue) therapies.
 Document assessment in patients PMR.
3. Thrombosis
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You will discontinue the infusion immediately once noted.
You should remove the catheter.
Assess site of injury frequently.
Avoid by changing site every 72 hours and avoid the cannulation of the
lower extremities.
 Document assessment in PMR.
*You should assess & document the infusion of prescribed therapies at regular
intervals to establish effectiveness and patient tolerance, to avoid complications.