Intravenous Therapy Procedure PDF

Intravenous therapy By Dr./Walaa Zahran Dr./ Marwa Talaat  Definition:  Intravenous injection is the instillation into a vein of medications, fluids, blood, or nutrient substances and it can be intermittent or continuous administration.  Indicatio...

Intravenous therapy By Dr./Walaa Zahran Dr./ Marwa Talaat  Definition:  Intravenous injection is the instillation into a vein of medications, fluids, blood, or nutrient substances and it can be intermittent or continuous administration.  Indication 1. Maintain fluids &electrolyte balance and replacement. 2. Administer nutritional formula containing glucose, amino acids and lipid [Total parenteral Nutrition (TPN)]. 3. Administer medications that are more effective when given by this route or cannot be given by any other route. 4. Administer blood &blood products. 5. Administer chemotherapy to cancer patient. 6. Administer patient controlled analgesics. 7. Keep a vein open for quick access 8. IV administration of radiologic contrast agents for computed tomography (CT), magnetic resonance imaging (MRI), or nuclear imaging  Vein puncture site Basilic & cephalic veins. Hand veins: cephalic, basilic  and dorsal venous net work. Median cubital vein. Ulnar vein. Radial vein. Vein puncture site Vein puncture site Greater saphenous Vein  Peripheral I.V insertion principles Go by “feel”, not by sight. Good veins are bouncy to the touch, but are not always visible. Use warm compresses and allow the arm to hang dependently to fill veins. If the patient is NOT allergic to latex, using a latex tourniquet may provide better venous congestion  Peripheral I.V insertion principles - Avoid areas of joint flexion - Start distally  Peripheral I.V insertion principles -Use the shortest length/smallest gauge access device that will properly administer the prescribed therapy (less resistance and fewer complication)  What are the characteristics of good vein ?  Visible  Straight  Soft  Above previous insertion sites  Refills when depressed  Has a large lumen  Well supported/immobile  Bouncy/elastic  Easily palpable  Not bridging joints  What veins should you avoid ? Thrombosed / fibrosed veins Inflamed Thin / Fragile Mobile Near bony prominences Areas or sites of infection, oedema or phlebitis Have undergone multiple previous punctures  Equipments: Intravenous tray, including (tourniquet, alcohol swab ,adhesive tape, and dressing). Medications to be given. Clean gloves. Sterile syringe of appropriate size Vial or ampoule of prescribed medications Sharp container Patients prescription chart and recording chart. Procedure 1. Check doctor order. 2. Hand washing. 3. Wear disposable gloves and prepare equipment, and medications. 4. Explain patient procedures. 5. Inspect patient hands and fore arm and select the site for venipuncture. 6. Apply tourniquet 4-6 inch above the selected site & should be tight enough to impede venous return but not occlude arterial flow 7. Instruct patient to open & close the fist several times 8. Examine the selected vein by flicking your index finger lightly against it  Other technique for vein selection:  Vein viewer 9. Cleanse site with alcohol swab in a circular motion out ward for 2 inches, allow the area to dry 10. Stretch skin toward me to stabilize vein by placing thumb on non- dominant hand 1-2 inches below intended insertion site and gently pull skin 11. Holding needle with bevel up, Insert needle through the subcutaneous tissue at a (20-30) degree angle beside or directly into the vein. 12. When blood return is obtained decrease the angle of the catheter to 10 degrees and very carefully advance the needle and the catheter 13. Release tourniquet and ask patient to open his fist. 14. Inject the medication slowly and observe the skin 15. Remove the needle and press with dry sponge and plaster on the needle site 16. Recollect equipment and wash your hand 17.Documentation and report the administration on the appropriate chart Venous Blood Sample  DEFINITION Collect sample of blood usually collected from an appropriate vein for laboratory examination. INDICATIONS Help in making diagnosis Confirm diagnosis Follow the prognosis of diagnosis  EQUIPMENT'S 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 tap PROCEDURE Check doctor order Hand washing and wear gloves Collect and prepare equipment Label all collection tube with pt. name and room number, date and time of collection and signature Explain procedures to patient Inspect pt hands and fore arm and select the site for venipuncture.  Apply tourniquet 4-6 inch (10-15 cm) above the selected site, tourniquet should be applied at a pressure which is high enough to impede venous distension but not to restrict arterial flow  NEVER leave tourniquet in place for longer than 2-3 minutes. During site preparation, remove tourniquet to minimize discomfort for patient and reapply before actual venipuncture. Promote venous distention by instructing the patient to open and close the fist several times. Examine the selected vein by flicking your index finger lightly against it Cleanse site with alcohol swab in a circular motion out ward for 2 inches allow the area to dry  Stretch skin toward me to stabilize vein by placing thumb on non-dominant hand 1-2 inches below intended insertion site and gently pull skin to smooth insertion of the needle and decrease, patient discomfort. Holding needle with bevel up, Insert needle through the subcutaneous tissue at a 20-30 degree angle beside or directly into the vein. When blood return is obtained decrease the angle of the catheter to 10 degrees and very carefully advance the needle and the catheter Withdraw required amount of blood  Remove the tourniquet  Slowly remove needle and apply gentle pressure  Transfer sample to collection tubes, gently rotate each tube to help mix additives with sample  Send specimen to lab Remove equipment and dispose of sharp container Record procedures. Inserting IV cannula or needle  Contraindications for IV cannulation:- No absolute contraindications for IV cannulation exist. Peripheral venous access in an injured, infected, or burned extremity should be avoided.  Contraindications for IV cannulation:- Some irritant solutions (pH < 5, pH > 9, or osmolarity > 600 mOsm/L) can cause blistering and tissue necrosis if they leak into the tissue, including: sclerosing solutions, some chemotherapeutic agents, and vasopressors. These solutions are more safely infused into a central vein. They should only be given through a peripheral vein in emergency situations or when a central venous access is not readily available. Central viens 1. Intravenous tray, including (tourniquet, alcohol swab or special agent such as povidone- iodine (betadin), catheter, tubing, adhesive tape. 2. Clean gloves. 3. Medications to be given. 4. Sterile syringe of appropriate size 5. Saline flash 6. Sharp container 7. Patient's prescription chart, recording chart.  procedure 1. Check doctor orders 2. Wash hands and prepare equipment & check all expiry dates on equipment/materials. 3. Wear disposable gloves 4. Explain procedure to the patient.  Select a suitable vein by inspect patient hands and forearm and select the site for venipuncture  Apply tourniquet 10-15cm (4-6 inch) above the selected site & should be tight enough to impede venous return but not occlude arterial flow.  Promote venous distention by instructing the patient to open and close the fist several times.  Examine the selected vein by flicking your index finger lightly against it  Put on clean gloves  Cleanse site with alcohol swab in a circular motion out ward for 2 inches, allow the area to dry  Stretch skin toward you to stabilize vein by placing thumb of non-dominant hand  Remove the cannula from its packaging and remove the needle cover ensuring not to touch the needle.  Insert with bevel up at 20 to 30 degree angle then decreases 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, or if it causes any pain, or you notice any localized tissue 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 all sharps into sharp container  Finally Document the procedure including: Date & 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.) 77 Changing Dressing of Cannula  INDICATIONS 1. To prevent complications such as thrombophelepitis and infection. 2. Typically IV access dressing are changed every 48 hrs. 3. To change dressing which become wet, solid or non occlusive. EQUIPMENT'S Disposable exam gloves Alcohol or povidone-iodine wipes Sterile gauze sponges Transparent dressing Plastic bag for used supplies PROCEDURE hand washing and prepare equipment's explain procedures Apply disposable exam gloves Hold the cannula in place with non dominant hand. Then 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. Begin at the insertion site, working outward Allow the skin cleanser to dry Completely. Remove gloves and discard in plastic bag. Apply adhesive tape and label the last piece of tape Collect equipment and wash hands Documents the procedure ANY QUESTIONS  Removal of IV cannula Perform hand hygiene with soap and water or alcohol based hand rub Wear gloves Assess insertion site  Clamp tubing Remove tape in direction of hair growth while securing IV catheter. Use alcohol swab or double-sided tape to lift edge of dressing  Use the tape to help you slowly peel back the dressing Remove catheter using a slow steady movement and keeping the hub parallel to the skin  With extremity elevated, gently apply pressure with dry sterile gauze to insertion site until bleeding stops Assess IV catheter’s integrity and length. Dispose of IV catheter into 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