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Institutional UsersAccess through Ovid® Not a Subscriber?Buy Subscribe Request Permissions You can read the full text of this article if you: Log In Access through Ovid Department: upFront: I.V. ROUNDS Hadaway, Lynn C. RN-BC, CRNI, MEd Lynn C. Hadaway is the president of Lynn Hadaway
Associates, Inc., in Milner, Ga. Adapted and updated from Hadaway L. Preventing and managing peripheral extravasation. Nursing. 2004;34(5):66–67. Nursing: October 2009 - Volume 39 - Issue 10 - p 26-27
doi: 10.1097/01.NURSE.0000361260.92163.c1 Full Text Access for Subscribers:
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Institutional UsersAccess through Ovid® Not a Subscriber?Buy Subscribe Request Permissions You can read the full text of this article if you: Log In Access through Ovid Departments: I.V. Essentials ROSENTHAL, KELLI RN, BC, APRN, BC, CRNI, MS President and Chief Executive Officer,
ResourceNurse.Com, Oceanside, N.Y. Nursing Made Incredibly Easy!: November 2003 - Volume 1 - Issue 2 - p 60-62 Chapter 8. Intravenous Therapy Intravenous therapy is treatment that infuses intravenous solutions, medications, blood, or blood products directly into a vein (Perry, Potter, & Ostendorf, 2014). Intravenous therapy is an effective and fast-acting way to administer fluid or medication treatment in an emergency situation, and for patients who are unable to take medications orally. Approximately 80% of all patients in the hospital setting will receive intravenous therapy. The most common reasons for IV therapy (Waitt, Waitt, & Pirmohamed, 2004) include:
Guidelines Related to Intravenous TherapyThe following are general guidelines for peripheral IV therapy:
Types of Venous AccessSafe and reliable venous access for infusions is a critical component of patient care in the acute and community health setting. There are a variety of options available, and a venous access device must be selected based on the duration of IV therapy, type of medication or solution to be infused, and the needs of the patient. In practice, it is important to understand the options of appropriate devices available. This section will describe two types of venous access: peripheral IV access and central venous catheters. Peripheral IVA peripheral IV is a common, preferred method for short-term IV therapy in the hospital setting. A peripheral IV (PIV) (see Figure 8.1) is a short intravenous catheter inserted by percutaneous venipuncture into a peripheral vein, held in place with a sterile transparent dressing to keep the site sterile and prevent accidental dislodgement (CDC, 2011). Upper extremities (hands and arms) are the preferred sites for insertion by a specially trained health care provider. If a lower extremity is used, remove the peripheral IV and re-site in the upper extremities as soon as possible (CDC, 2011; McCallum & Higgins, 2012). The hub of a short intravenous catheter is usually attached to IV extension tubing with a positive pressure cap (Fraser Health Authority, 2014). PIVs are used for infusions under six days and for solutions that are iso-osmotic or near iso-osmotic (CDC, 2011). They are easy to monitor and can be inserted at the bedside. CDC (2011) recommends that PIVs be replaced every 72 to 96 hours to prevent infection and phlebitis in adults. Most agencies require training to initiate IV therapy, but the care and preparation of equipment, and the maintenance of an IV system can be completed each shift by the trained health care provider. For more information on how to initiate IV therapy, see the resources at the end of the chapter. Figure 8.1 Peripheral intravenous (IV) catheter (PIV)PIVs are prone to phlebitis and infection, and should be removed (CDC, 2011) as follows:
Several potential complications may arise from peripheral intravenous therapy. It is the responsibility of the health care provider to monitor for signs and symptoms of complications and intervene appropriately. Complications can be categorized as local or systemic. Most complications are avoidable if simple hand hygiene and safe principles are adhered to for each patient at every point of contact (Fraser Health Authority, 2014; McCallum & Higgins, 2012). Table 8.1 lists the potential local and complications and treatment. Table 8.1 Potential Local Complications of Peripheral IV Therapy
Systemic complications can occur apart from chemical or mechanical complications. To review the systemic complications of IV therapy, see Table 8.2. Table 8.2 Systemic Complications of Peripheral IV Therapy
Central Venous CathetersA central venous catheter (CVC) (see Figure 8.2), also known as a central line or central venous access device, is an intravenous catheter that is inserted into a large vein in the central circulation system, where the tip of the catheter terminates in the superior vena cava (SVC) that leads to an area just above the right atrium. CVCs have become common in health care settings for patients who require IV medication administration and other IV treatment requirements. CVCs can remain in place for more than one year. Some CVC devices may be inserted at the bedside, while other central lines are inserted surgically. Central lines are inserted by a physician or specially trained health care provider, and the use of ultrasound guided placement is recommended to reduce time of insertion and complications (Safer Healthcare Now, 2012). A CVC has many advantages over a peripheral IV line, including the ability to deliver fluids or medications that would be overly irritating to peripheral veins, and the ability to access multiple lumens to deliver multiple medications at the same time (Fraser Health Authority, 2014). Central venous catheters can be inserted percutaneously or surgically through the jugular, subclavian, or femoral veins, or via the chest or upper arm peripheral veins (Perry et al., 2014). Femoral veins are not recommended, as the rate of infection is increased in adults (CDC, 2011; Safer Healthcare Now, 2012). To have a CVC inserted or removed, an order by a physician or nurse practitioner must be obtained. Site selection for a CVC may be based on numerous factors, such as the condition of the patient, patient’s age, and type and duration of IV therapy. The majority of patients in an ICU will have a CVC to receive fluids and medications. A chest X-ray is given to determine correct placement before inserting, or to confirm a suspected dislodgement (Fraser Health Authority, 2014). An IV pump must be used with all CVCs to prevent complications. CVCs are typically inserted for patients requiring more than six days of intravenous therapy or who:
A central line is made up of lumens. A lumen is a small hollow channel within the CVC tube. A CVC may have single, double, triple, or quadruple lumens (Perry et al., 2014). Depending on the type of CVC, it may be internally or externally inserted, and may have an open-ended or valved tip. Open-ended devices are those in which the catheter tip is open like a “straw.” These have a higher risk for complications, such as hemorrhage, air embolism, and occlusion from fibrin or clots. Valved devices are those in which the tip is configured with a three-way pressure-activated valve (Perry et al., 2014). It is important to know what type of central line is being used, as this will impact how to care for and manage the equipment for specific procedures. Table 8.3 lists various types of central lines. Table 8.3 Types of Central Venous Catheters (CVCs)
CVCs have specific protocols for accessing, flushing, disconnecting, and assessment. All health care providers require specialized training to care for, manage complications related to, and maintain CVCs as per agency policy. Never access or use a central line for IV therapy unless trained as per agency policy. For more information on CVC care and maintenance, see the suggested online reference list at the end of this chapter. Health care providers should assess a patient with a central line at the beginning and the end of every shift, and as needed. For example, if the central line has been compromised (pulled or kinked), ensure it is functioning correctly. Each assessment should include:
See Table 8.4 for a list of complications, signs and symptoms, and interventions. Table 8.4 Potential Complications with Central Venous Catheters
How do you prevent an infiltrated IV?Preventing infiltration starts with choosing the right vein for the job. Select veins that feel smooth and resilient, not hard or cordlike. Avoid areas of flexion; the catheter could too easily become dislodged.
What are the recommended nursing interventions when an IV becomes infiltrated?If you are concerned an IV is infiltrated, follow your facility policy and as a general guideline, discontinue the site and relocate the IV. If the infiltration is severe, apply warm compresses, elevate the arm, monitor the site and be sure to inform the healthcare provider.
What is the most important action the nurse can take to protect the patient when administering a medication by IV bolus?Injecting the medication at the prescribed rate is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus, since injecting the medication faster than recommended may result in injury or death.
How do you administer Secondary IV?Hang the secondary IV solution on the IV pole with the primary bag lower than the secondary bag. Label the secondary tubing near the drip chamber. Set the infusion rate: For infusion pump: Set the volume to be infused and the rate (mL/hr) to be administered based on the provider order.
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