IV Therapy Equipment and procedures 1

IV Therapy Definitions

• Antimicrobial - Substance that kills or inhibits the growth of microorganisms. Crucial for preventing infections in IV therapy.
• Cannula - Plastic part of a catheter that remains in the vein after needle removal.
• Bevel - Slanted opening at a needle's tip. Always positioned upward during venipuncture.
• Priming - Filling new IV tubing with fluid before use. Prevents air embolisms, a potentially life-threatening complication.
• Spiking - Connecting IV tubing to a fluid bag. Requires careful handling to avoid punctures.
• Proximal - Towards the body's trunk.
• Distal - Towards the body's extremities.
• PICC Line (Peripherally Inserted Central Catheter) - Central line inserted into a peripheral vein, guided to the central circulation. Requires RN placement and maintenance.
• Hickman Port - Central line with similar requirements to a PICC line.
• Implanted Port - Central line surgically placed beneath the skin for long-term therapy, often for chemotherapy. Requires RN access.

IV Catheter Parts and Types

• Safety Catheters - Designed for minimizing needle stick injuries. Include a push-off tab and activation button that retracts the needle after insertion.
• Standard Catheters - May have a hub and wings. Function like safety catheters.

IV Gauge Sizes

• Smaller gauge number = Larger needle diameter.
• Commonly used gauges: 16, 18, 20, and 22 gauge.
• 14 Gauge - Massive trauma, blood transfusions, high-volume fluids.
• 16 Gauge - Trauma, surgeries, blood transfusions, large volume infusions.
• 18 Gauge - Surgeries, blood transfusions, large volume infusions.
• 20 Gauge - Multi-purpose, suitable for most medications and fluids.
• 22 Gauge - Smaller veins, elderly and pediatric patients.
• 24 Gauge - Very small veins.

Infection Control

• Primary Goal - Prevent IV-related infections.
• Methods - Hand hygiene, sterile technique, standard precautions.
• Chain of Infection - Needs to be broken: infectious agent, reservoir, portal of exit, transmission, portal of entry, susceptible host.
• Common IV-Related Infections - Staphylococcus aureus, Candida albicans, Klebsiella, E. coli.
• Nosocomial Infections - Often linked to breaks in sterile technique.
• Signs of Infection - Chills, malaise, fever, elevated white blood cell count, redness at the IV site (phlebitis).
• Preventing Infection - Follow protocols for site and tubing changes. Check expiration dates on fluids, medications, and equipment. Use filters and extension tubing properly. Report signs of infection promptly. Culture IV sites and equipment if needed.

Patient Preparation

• Assess Patient History - Previous IV experiences.
• Provide Education - Explain the procedure.
• Clothing Change - Ensure patient uses a hospital gown.
• Respect Patient Refusal - Patient refusal is legitimate and legally protected.
• Communication - Be non-judgmental, listen to concerns, provide reassurance, investigate, and report/document any issues.

Suitable Veins for IV Therapy

• Digital Veins - Tiny veins in fingers, small gauge catheters (24 gauge) and isotonic solutions only.
• Metacarpal Veins - Hand veins, suitable for 20-22 gauge catheters. Avoid potassium, chemo, antibiotics, and chemically irritating substances.
• Cephalic Vein - Large radial forearm vein. Good for blood draws, irritating drugs, and long-term therapy.
• Basilic Vein - Ulnar forearm vein. Good for long-term therapy but easily rolls and can be challenging to access.
• Axillary Vein - Radial upper arm vein. Suitable for long-term therapy, irritating substances, and confused patients.
• Median Antebrachial Vein - Inner forearm. Typically challenging to initiate an IV.
• Median Cephalic Vein - Radial forearm.
• Median Basilic Vein - Ulnar forearm.
• External Jugular Vein - Advanced practice only, never used by LPNs.
• Lower Extremity Veins - Acceptable for children's IV therapy but not for adults unless specifically required due to high thrombophlebitis risk.

Factors Affecting Site Selection

• Type of Solution - Certain solutions are better suited for specific veins.
• Vein Condition - Look for inflammation, scarring, or trauma.
• Duration of Therapy - Long-term therapy needs a more durable vein.
• Cannula Size - Choose based on vein size and infusion type.
• Patient Age - Adults have larger, stronger veins; children and elderly have smaller veins.
• Patient Preference - Obtain patient input where possible.
• Patient Activity - Account for surgery or disease limitations (e.g., dominant arm use).
• Presence of Shunt/Graft - Never use veins with a shunt or graft.

Do's and Don'ts of Site Selection

• DOs: Use distal veins first, then proceed proximally. Palpate veins before venipuncture. Use first two fingers to palpate, not the thumb. Tap or warm the arm to improve vein visibility. Choose appropriate veins based on fluids used.
• DON'Ts: Use veins with knots, scars, or inflammation. Use dominant arm veins if shunt/graft exists. Use lower extremities for adult IV therapy unless ordered.

IV Site Selection: Don'ts

• Avoid lower extremities in non-ambulatory adults/children (thrombophlebitis risk).
• Avoid irritated or scarred veins.
• Avoid areas of flexion (catheter dislodgement risk).
• Avoid tourniquets on fragile veins (elderly patients).
• Avoid mastectomy or stroke-affected sites.
• Avoid partially amputated limbs, surgical sites, or third-degree burns.

Factors Affecting Vein Dilation

• Blood pressure - High blood pressure makes vein access harder.
• Valves - Valvular insufficiency hinders catheter advancement.
• Sclerotic veins - Veins hardened by previous IV attempts.
• Multiple previous IV sticks - Creates difficulty in finding usable veins.

Methods to Dilate Veins

• Gravity - Holding the arm down promotes vein distention.
• Clenching - Patient making a fist can make veins more prominent.
• Tapping - Gently tapping encourages dilation.
• Warm compresses - Promote vein dilation.
• Tourniquet - Above the site; aids vein distention.
• Blood pressure cuff - Alternative to tourniquets for some patients.

IV Administration Equipment

• Butterflies - Winged needles for IV access.
• CVCs or PICC lines - Long-term IV therapy.
• Fluid containers -
  • Glass - Less common; offers visibility and reduces medication leaching.
  • Plastic - More common; can cause medication adherence and punctures.
• Vented sets - Required with glass containers.
• IV tubing -
  • Primary - Continuous or PRN infusions.
  • Secondary - Intermittent infusions (e.g., antibiotics).
  • Pediatric (T-sets) - Prevents fluid overload in children.
• Blood sets - Blood transfusions; Y-site for saline with blood.
• Extension sets - Extend reach.
• PRIs/Intercath (Hep-locks) - Intermittent medication administration; requires flushing.
• Needleless systems - Safer; use spikes or lure locks with one-way valves.

Methods of Regulating IV Fluids

• Gravity - Controls flow rate (drops per minute) using clamps. Factors influencing flow rate:
  • Container height - Higher height = faster flow.
  • Container weight - Heavier container = faster flow.
  • Lumen diameter - Wider lumen = faster flow.
  • Tubing length - Shorter tubing = faster flow.
  • Fluid viscosity - Thinner fluid = faster flow.
  • Resistance - Kinks or clamps obstruct flow.
• Electronic pumps - Deliver fluids accurately and consistently.