Intravenous Therapy and Techniques

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Questions and Answers

What is a characteristic that indicates a good vein for intravenous therapy?

Mobile and flexible

Located near bony prominences

Bouncy and elastic (correct)

Thrombosed and fibrosed

Which of the following is NOT an indication for intravenous therapy?

Administer medications that cannot be given orally

Maintain pulmonary function (correct)

Administer Total parenteral Nutrition (TPN)

Keep a vein open for quick access

What should be avoided when selecting a vein for intravenous insertion?

Well-supported veins

Veins that are easily palpable

Thin and fragile veins (correct)

Straight and soft veins

Which principle is recommended when performing peripheral IV insertion?

Go by feel rather than sight Signup and view all the answers

What is a common reason for administering chemotherapy via intravenous therapy?

To provide immediate drug effect Signup and view all the answers

Which equipment is essential for performing intravenous therapy?

Intravenous tray with necessary supplies Signup and view all the answers

For effective venous access, which method is advised to help fill the veins?

Allowing the arm to hang dependently Signup and view all the answers

Which of the following vein types should be approached for intravenous therapy?

Bouncy and well-supported veins Signup and view all the answers

What is the correct distance to apply a tourniquet above the selected venipuncture site?

4-6 inches Signup and view all the answers

What should be done immediately after obtaining blood return during venipuncture?

Decrease the angle of the catheter to 10 degrees Signup and view all the answers

Which of the following is considered a contraindication for peripheral venous access?

Infected extremities Signup and view all the answers

How should the skin be cleansed before a venipuncture?

In a circular motion outward for 2 inches Signup and view all the answers

What is the maximum duration a tourniquet should remain in place during the procedure?

2-3 minutes Signup and view all the answers

What is a key action to promote venous distention before venipuncture?

Encourage the patient to make a fist several times Signup and view all the answers

When should the tourniquet be removed during the venipuncture process?

Before actual venipuncture Signup and view all the answers

What is the correct angle at which the needle should be inserted during venipuncture?

20-30 degrees Signup and view all the answers

Which solution should not be infused through a peripheral vein due to potential tissue damage?

Sclerosing solutions Signup and view all the answers

Which step is crucial after obtaining blood return from the vein?

Decrease the angle of the catheter Signup and view all the answers

What should be done with the tourniquet before injecting the medication?

It should be removed before the injection Signup and view all the answers

What is the purpose of flicking the index finger against the selected vein?

To assess the vein's firmness Signup and view all the answers

What is the primary reason for cleaning the venipuncture site with an alcohol swab?

To disinfect the skin Signup and view all the answers

What should be done with the needle site after removing the needle?

Press with a dry sponge and apply a plaster Signup and view all the answers

Which item is NOT necessary for collecting a venous blood sample?

Ultrasound machine Signup and view all the answers

What should be included in the labeling of the collection tube?

Patient's name, room number, date, and time of collection Signup and view all the answers

What is the correct angle of insertion for the needle during venipuncture?

20 to 30 degrees Signup and view all the answers

How should the skin be stabilized during the procedure of venipuncture?

By stretching the skin toward the patient Signup and view all the answers

What should be done immediately upon observing resistance or pain during flushing of the cannula?

Stop flushing and remove the cannula Signup and view all the answers

What is the maximum duration a cannula can remain in place without a proper risk assessment?

72 hours Signup and view all the answers

What is the purpose of applying a tourniquet during venipuncture?

To promote venous distention Signup and view all the answers

Which of the following indicates that the dressing on a cannula should be changed?

It becomes wet or solid Signup and view all the answers

What is the first step to take after removing the needle following blood return during cannulation?

Apply pressure to the vein at the tip of the cannula Signup and view all the answers

What is the primary reason for cleansing the skin around the insertion site before IV cannula removal?

To prevent contamination and infection Signup and view all the answers

What should be documented after completing the cannulation procedure?

Problems encountered and the site of insertion Signup and view all the answers

How should the adhesive tape be removed when taking out an IV cannula?

In the direction of hair growth while securing the catheter Signup and view all the answers

What should be done immediately after removing the IV catheter to ensure bleeding stops?

Gently apply pressure with dry sterile gauze Signup and view all the answers

What action should be taken with the IV catheter after it has been removed?

Dispose of it in a sharps container Signup and view all the answers

What is the final step in the IV cannula removal procedure?

Document the procedure in the patient’s records Signup and view all the answers

Study Notes

Intravenous Therapy: Definition and Indications

Intravenous (IV) therapy involves administering medications, fluids, blood, or nutrients directly into a vein.
It can be administered intermittently or continuously.
Key Indications:
- Maintaining fluid and electrolyte balance
- Replacing electrolytes
- Administering nutritional formulas (Total Parenteral Nutrition - TPN)
- Delivering medications that are more effective or only possible through IV route
- Administering blood and blood products
- Chemotherapy for cancer patients
- Patient-controlled analgesia
- Keeping a vein open for quick access
- Administering radiologic contrast agents for imaging procedures (CT, MRI, nuclear imaging)

Vein Puncture Sites

Common sites include:
- Basilic and cephalic veins
- Hand veins: cephalic, basilic, dorsal venous network
- Median cubital vein
- Ulnar vein
- Radial vein
- Greater saphenous vein

Peripheral IV Insertion Principles

Focus on "feel" over sight: Good veins are bouncy but not always visible.
Warm compresses and dependent arm position: Encourage vein filling.
Latex tourniquet (if no allergy): Improves venous congestion.
Avoid areas of joint flexion: Minimize discomfort and risk of dislodgment.
Start distally: Begin insertion at a point furthest from the heart, allowing for easier access.
Shortest length/smallest gauge: Use the smallest possible device that will deliver the therapy effectively, reducing resistance and complications.

Characteristics of a Good Vein for IV Access

Visible
Straight
Soft
Above previous insertion sites
Refills when depressed
Large lumen (internal diameter)
Well supported/immobile
Bouncy/elastic
Easily palpable (can be felt)
Not bridging joints

Veins to Avoid

Thrombosed/fibrosed veins (clotting or scarring)
Inflamed veins
Thin/fragile veins
Mobile veins
Veins near bony prominences
Areas with infection, edema (swelling), or phlebitis (inflammation of a vein)
Veins that have undergone multiple punctures

Equipment for IV Therapy

Intravenous tray: Includes tourniquet, alcohol swab, adhesive tape, dressing
Medications to be given
Clean gloves
Sterile syringe of appropriate size
Vial or ampoule of prescribed medications
Sharp container
Patient's prescription chart and recording chart

IV Insertion Procedure

Check doctor's orders.
Wash hands thoroughly.
Prepare equipment and medications.
Explain the procedure to the patient.
Inspect the patient's hands and forearm to select the best site.
Apply tourniquet: 4-6 inches above the selected site, tight enough to impede venous return but not occlude arterial flow.
Instruct the patient to open and close their fist several times to promote venous distention.
Examine the selected vein by lightly flicking it with your index finger.
Vein Viewer: Can be used as a visual aid for vein selection for difficult cases.
Cleanse the site with an alcohol swab in a circular motion outward for 2 inches, allow to dry.
Stretch the skin toward you to stabilize the vein: Place your thumb 1-2 inches below the insertion site and gently pull.
Insert needle with bevel up at a 20-30 degree angle: Aim beside or directly into the vein.
When blood return is obtained, decrease the angle to 10 degrees and carefully advance the needle and catheter.
Release the tourniquet and ask the patient to open their fist.
Inject medications slowly and observe the skin for any signs of reaction.
Remove the needle and press with a dry sponge and plaster on the site.
Recollect equipment and wash hands.
Document and report the administration on the appropriate chart.

Venous Blood Sample Collection

Definition: Obtaining blood from a vein for laboratory analysis.
Indications:
- Making a diagnosis
- Confirming a diagnosis
- Following the progress of a diagnosis

Equipment for Venous Blood Collection

Dry sterile syringe
Tourniquet
Sterile gloves
Alcohol sponge and dry cotton sponge
Sterile or clean, colored and coded test tube (containing appropriate additives)
Labels, laboratory request form, and adhesive tape

Venous Blood Collection Procedure

Check doctor's orders.
Wash hands and wear gloves.
Collect and prepare equipment.
Label all collection tubes with patient name, room number, date, time, and your signature.
Explain the procedure to the patient.
Inspect the patient's hands and forearm to select the site for venipuncture.
Apply a tourniquet 4-6 inches (10-15 cm) above the selected site. Pressure should impede venous distention but not restrict arterial flow.
Never leave the tourniquet in place for longer than 2-3 minutes. Remove during site preparation and reapply before venipuncture.
Promote venous distention by instructing the patient to open and close their fist several times.
Examine the selected vein by lightly flicking it with your index finger.
Cleanse the site with an alcohol swab in a circular motion outward for 2 inches, allow to dry.
Stretch the skin toward you to stabilize the vein: Place your thumb 1-2 inches below the insertion site and gently pull.
Insert needle with bevel up at a 20-30 degree angle: Aim beside or directly into the vein.
When blood return is obtained, decrease the angle to 10 degrees and carefully advance the needle and catheter.
Withdraw the required amount of blood.
Remove the tourniquet.
Slowly remove the needle and apply gentle pressure.
Transfer the sample to collection tubes, gently rotate each tube to help mix additives with the sample.
Send the specimen to the lab.
Remove equipment and dispose of sharps in the designated container.
Record the procedure.

IV Cannula (Catheter) Insertion

No absolute contraindications for IV cannulation.
Avoid injured, infected, or burned extremities.
Irritant solutions (pH < 5, pH > 9, or osmolarity > 600 mOsm/L): Can cause blistering and tissue necrosis if they leak into tissues. These should generally be infused into central veins, only using peripheral veins in emergencies.

IV Cannula Insertion Equipment

Intravenous tray: Includes tourniquet, alcohol swab, or povidone-iodine, catheter, tubing, adhesive tape.
Clean gloves.
Medications to be given.
Sterile syringe of appropriate size.
Saline flash.
Sharp container.
Patient’s prescription chart and recording chart.

IV Cannula Insertion Procedure

Check doctor's orders.
Wash hands thoroughly and check all expiry dates on equipment/materials.
Wear disposable gloves.
Explain the procedure to the patient.
Select a suitable vein by inspecting the patient's hands and forearm.
Apply tourniquet 4-6 inches (10-15 cm) above the selected site. Pressure should impede venous return but not restrict arterial flow.
Promote venous distention by instructing the patient to open and close their fist several times.
Examine the selected vein by lightly flicking it with your index finger.
Cleanse the site with an alcohol swab in a circular motion outward for 2 inches, allow to dry.
Stretch the skin toward you to stabilize the vein: Place your thumb 1-2 inches below the insertion site and gently pull.
Remove the cannula from its packaging and remove the needle cover ensuring not to touch the needle.
Insert with bevel up at a 20-30 degree angle then decrease the angle of the catheter. Observe for blood in the flashback chamber.
When blood return is obtained, decrease the angle of the catheter and very carefully advance the needle and the catheter.
Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully. Remove the cap from the needle and put this on the end of the cannula. Carefully dispose of the needle into the sharps bin.
Apply the dressing to the cannula to fix it in place and ensure that the date sticker has been completed and applied.
Fill the syringe with saline and flush it through the cannula to check for patency. If there is any resistance, pain, or localized swelling, immediately stop flushing, remove the cannula, and start again.
Label the last piece of tape with the date and time of insertion and your signature.
Remove unnecessary equipment and dispose of all sharps into the sharp container.
Document the procedure:
- Date and time
- Site and size of cannula
- Any problems encountered
- Review date (cannula should be in situ no longer than 72 hours without appropriate risk assessment)

Changing the Dressing of a Cannula

Indications:
- Prevent complications: thrombophelepitis (blood clot in a vein), infection.
- Typically changed every 48 hours.
- Change dressings that are wet, solid, or non-occlusive.

Equipment for Changing Cannula Dressings

Disposable exam gloves
Alcohol or povidone-iodine wipes
Sterile gauze sponges
Transparent dressing
Plastic bag for used supplies

Changing Cannula Dressing Procedure

Wash hands thoroughly and prepare equipment.
Explain the procedure.
Apply disposable exam gloves.
Hold the cannula in place with your non-dominant hand.
Loosen the adhesive in one corner and remove the dressing by peeling it back toward the insertion site.
Evaluate the insertion site for redness, swelling, drainage, or other complications.
Cleanse the skin with alcohol or povidone-iodine for 3 inches surrounding the insertion site, working outward from the insertion site.
Allow the skin cleanser to dry completely.
Remove gloves and discard in the plastic bag.
Apply adhesive tape and label the last piece of tape.
Collect equipment and wash hands.
Document the procedure.

Removal of an IV Cannula

Perform hand hygiene with soap and water or alcohol-based hand rub.
Wear gloves.
Assess the insertion site.
Clamp the tubing.
Remove the tape in the direction of hair growth while securing the IV catheter. Use an alcohol swab or double-sided tape to lift the edge of the dressing.
Use the tape to help you slowly peel back the dressing.
Remove the catheter using a slow steady movement and keeping the hub parallel to the skin.
With the extremity elevated, gently apply pressure with dry sterile gauze to the insertion site until bleeding stops.
Assess the IV catheter's integrity and length. Dispose of the IV catheter in the sharps container.
Apply a suitable dressing to the site where the cannula has been removed.
Make a record of the procedure in all relevant documentation.

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Description

This quiz covers the fundamentals of intravenous therapy, including its definition, indications, and various vein puncture sites for IV insertion. Test your knowledge on the administration of fluids, medications, and nutritional formulas through IV. Ideal for nursing and medical students.