IV Therapy Best Practices

• Venipuncture and cannulation are important medical procedures.

IV Cannulation

• IV cannulation is a technique where a cannula is placed inside a vein to provide venous access.
• The purpose of IV cannulation is to:
  • Obtain a blood sample.
  • Administer fluids, meds, TPN(Total Parenteral Nutrition), chemo, or blood products.

IV Access Devices

• Types of IV access devices include:
  • Peripheral catheter.
  • Peripherally inserted central catheter (PICC line).
  • Central line:
    • Jugular
    • Subclavian
    • Femoral

IV Cannula Parts

• An IV cannula includes a safety needle cover, flashback chamber, needle grip, hub & wings, needle, and catheter.

IV Cannula Sizes

• IV Cannulas come in size:
  • 14g
  • 16g
  • 18g
  • 20g
  • 22g
  • 24g

Supplies Needed

• Supplies needed for IV cannulation include:
  • Tourniquet
  • Cotton balls
  • Gauze
  • Alcohol pads
  • IV catheter (20 or 22 gauge)
  • Extension set/connector
  • Saline flush (5 mL)
  • Saline bag
  • IV tubing set
  • IV start kit
  • Sharps container

Site Selection Considerations

• Factors to consider when selecting a site:
  • Avoid extensive scarring or healed burn areas.
  • Avoid areas containing trauma.
  • IVs should not be placed on the same side as a mastectomy.
  • Avoid areas of hematoma.
  • Avoid placing an IV in an arm with a cannula, fistula, or vascular graft.
  • If the patient is being transported, place the IV as distally as possible.
  • Avoid areas where the vein bifurcates.

Venipuncture Restrictions

• Venipuncture should not be performed on:
  • The arm on the side of a mastectomy due to possible inaccurate results from lymph edema.
  • Scarred or burned areas due to difficult tissue.
  • An arm where blood is being transfused or has an IV cannula.
  • Areas with hematoma to avoid incorrect test results.
  • Edematous areas which could alter test results.

Vein Selection Procedure

• Procedure for proper vein selection:
  • Palpate and trace the path of veins with the index finger to identify arteries and thrombosed veins.
  • If superficial veins are not readily apparent, force blood into the vein.
    • Massage the arm.
    • Tap the site
    • Apply a warm, damp washcloth.
    • Lower the extremity.
  • Healthy veins feel soft and bouncy and refill when depressed.

Improving Venous Access

• Methods to improve venous access:
  • Apply a Tourniquet to promote venous distension.
  • Ensure the tourniquet is tight enough to impede venous return but not restrict arterial flow.
  • The tourniquet should be 7 - 8 cm above the venipuncture site.
  • Limit tourniquet use to under 1 minute to avoid hemoconcentration.

Skin Preparation

• Asepsis is vital when breaching the skin with a foreign device.
• Skin cleaning is a debated topic.
  • A quick wipe with an alcohol swab does more harm than good.
• Prepare the Site by:
  • Ensuring the skin is prepared and cleaned.
  • Clipping hair for better visualization.
  • Using an antiseptic for at least 30 seconds.
  • Alternatives include:
    • Iodine tincture 1% to 2%.
    • Isopropyl alcohol 70%.

Venipuncture Procedure Steps

• Venipuncture procedure steps acronym:
  • Approach and Communication
  • Introduce self & check patient's ID
  • Explain desired action & its purpose
  • Gain consent & check for allergies, shunts, etc.
  • Review the treatment plan & individuals' history
  • Talk through it considerately and courteously
• Maintain Sterility by:
  • Washing your hands.
  • Cleaning and prepare procedure tray according to guidelines.
  • Collect equipment into the tray, without contaminating key parts
• Use Equipment like:
  • Skin cleansing wipes
  • Tourniquet
  • Gloves
  • Gauze swabs
  • Adhesive dressing
  • Needles
  • Blood collection tube(s)
  • Sharps container
• Preparation involves:
  • Sitting the patient in a suitable chair or lying down.
  • Supporting the arm on a pillow &, position the patient's arm as needed.
  • Checking for contra-indications e.g. infection or trauma.
  • Select a suitable vein.
  • Clean the site for 30 seconds (DO NOT TOUCH AGAIN).
  • Leave to dry.
  • Release Tourniquet.

Needle Insertion

• Insertion involves:
  • Anchoring the Vein to grasp arm with your non-dominant hand & use thumb to pull skin taut.
  • Smoothly and confidently insert the needle bevel up.
    • Aim for a 15 - 30-degree angle.

Device Insertion

• Device insertion involves:
  • Continuing holding the skin taut.
  • Use the device's push-off tab to separate catheter from needle stylet.
  • Advance the catheter into the vein to watch for 2nd flashback in catheter.
  • Apply pressure above catheter tip to reduce blood leakage with a finger.

Extension Tubing Use.

• Release the tourniquet.
• Place 2x2 under the catheter hub.
• Attach saline flushed extension tubing.
• Ensure a tight connection.
• Flush the catheter.

Dressing Application

• Apply a transparent semipermeable dressing the insertion site.
• Curl the extension set to the side and tape it to the patient's arm.
• Do not place tape over clear dressing window.
• Label the dressing with the current date and time.
• Consider tubular netting to help secure catheter.
  • Must pull back netting every 2 hours at minimum.

Vein Finder Devices

• Vein finder devices are an alternative technique.
• Laser/infrared technology may be utilized for vein viewing.
• Examples include:
  • Veinlite
  • AccuVein
  • VeinViewer Flex

IV Placement Steps Reminder

• Use universal precautions for bloodborne pathogens.
• Tie a tourniquet on the upper arm.
• Palpate and locate a vein.
• Insert needle into the vein and get "flash" of blood.
• Advance the catheter and withdraw the needle.
• Release the tourniquet.
• Flush the IV with normal saline.
• Attach the IV tubing.
• Anchor the IV at the catheter site.

IV Cannulation Complications

• IV cannulation complications may include:
  • Infiltration and extravasation.
  • Infection.
  • Thrombophlebitis is caused by local damage to the venous wall.
  • Air embolism.
  • Arterial placement.
  • Catheter fracture and embolism.

This lesson covers various aspects of IV therapy. It includes proper technique such as site selection, preventing complications, and general infusion administration. The lesson also highlights the importance of regular monitoring.