intravenous therapy

1. INTRAVENOU
S THERAPY

2. IV Statistics
 85% of all
hospitalized
patients have some
type of IV therapy
 118 million IV
catheters inserted
yearly

3. COMPLICATIONS

4. 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

7. Preventions
Choose vein appropriately
 Location
 Size
 Soft, spongy,
resilient
 No pain or
tenderness or
redness with
injection

8. INFILTRATION
 Leaking of nonvesicant fluid into
tissues surrounding the vein
 Check IV site every two hours
 Complications
 Nerve compression requiring
fasciotomy

10. EXTRAVASATION
 Inadvertent administration of vesicant drug into
surrounding tissues
 Calcium
 Magnesium
 Phenergan
 Potassium chloride
 Antibiotics
 Chemotherapy drugs
 Vasopressors (Dopamine, epinephrine)
 Dextrose > 10%
 Lorazepam
 Dilantin

12. 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.

13. 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

14. Causes
 Poor insertion site
 Squad starts
 Unsterile start
 IV left in too long—
change q 96 hours!
 Hub contamination

16. Cellulitis

17. Prevention
 Hand washing
 Sterile technique
 Catheter size
 Insertion site
 Site inspection every two hours
 Encourage patient to report any
discomfort

18. Patient’s Worst Nightmare!!!!

22. 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.

23. Muscle Man IV!

24. 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




25. 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

26. 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

27. 1. Put on Gloves!!!

28. 

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




STARTING AN IV (CONT.)

33. Advance cannula while holding stylet
stationary
Release tourniquet!!

34. 22. Withdraw stylet while putting pressure on
vein above injection site
Stabilize the hub of the canula

35. 23. Insert tubing or prn adaptor
Apply pressure above
insertion site to slow
bleeding
Stabilize the hub of the canula
while inserting the tubing
Saline flush is already attached and
tubing flushed and ready

36. It may get messy sometimes, but with experience
this will be minimized

37. • 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.

38. 1. Apply clear sterile dressing. Cover site and hub, not tubing
Leave the end of the hub
of the canula outside the
dressing so that tubing
can be changed without
removing the dressing.

39. 27. Date, time and initial site and tubing

40. STARTING AN IV (CONT.)
3. Document!

41. What is wrong
with this picture?

42. Dartmouth

46. Power Port

50. 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.

51. Apply a transparent semi-permeable dressing over the entire site.
medisim@lww.com.
http://www.youtube.com/watch?v=tfQbbCx6xFU&feature=related
http://www.youtube.com/watch?v=ZcCWTEsEqPg&feature=related