IV Insertion

Question 1

What does initiation of peripheral intravenous mean?

Answer 1

It’s the insertion of a radio-opaque short IV catheter into a vein in the periphery

Question 2

How long is a short IV catheter?

Answer 2

less than 3 inches

Question 3

Purpose of IV therapy?

Answer 3

To introduce fluids, meds, or blood products into the intravascular system for the following reasons:

• maintain and/or correct fluid and electrolyte balance
• Admin blood or blood products
• To keep a vein open for emergency access
• provide supplemental/parental nutrition due to compromised gastrointestinal system

Question 4

Know which veins are the best for IV insertion points (the vein graph)

• know what veins there are and where they are. there’s 2 diagrams w with vein pathways
• would be slide 15ish

Question 5

Anatomy of a vein: what is the general pathway of the venous system?

Answer 5

Blood leaving the capillaries return to the heart via the venous system

• beginning with venules
• progressing to larger veins
• leads to superior and inferior vena cava
• then enters the right atrium

Question 6

Describe what veins are + general characteristics

Answer 6

Highly distension thin walled vessels

• act as volume reservoir for circulatory system
• at any given time, contain about 50% of the body’s blood volume
• Veins have valves that keep blood moving back to the heart

Question 7

3 layers of veins?

Answer 7

• Tunica External (outer layer)
• Tunica media (middle layer)
• Tunica intima (internal)

Question 8

Describe the each of the layers of the veins (in 3 cards)

• know slides 15-18

Question 9

Which vein layer does clotting and thrombus formation occur in?

Answer 9

Tunica intima (internal)

Question 10

Add slide 13 (things to consider card)

Question 11

What are considerations when selecting a vein?

Answer 11

1. Purpose of infusion
2. Duration of therapy
3. Location
4. Areas to avoid

Question 12

What are infusion considerations when selecting a vein?

Answer 12

The infusion of large quantities of fluids, viscous fluids, hypertonic or highly irritating medications means that the larger diameter veins must be chosen in order to:

• allow for rapid infusion
• reduce the incidence of vascular irritability
• reduce the incidence of infiltration
• the above prevent restart occurrences

Question 13

which veins are the most stable and reliable sites for insertion?

Answer 13

Generally, bigger veins = More stable and reliable.

• use the one furthest down the arm if possible, gives options that are higher up the arm if needed

Question 14

What are considerations for long term IV therapy?

Answer 14

Veins must be preserved so its best to start as distal as possible on the forearm

• use the non dominate hand
• choose IV site proximal to the last site if there are problems with the initial site

Question 15

Areas to avoid when inserting IV lines

Answer 15

• Areas of flexion (i.e antecubital fossa)
• Digital veins (fingers bc small and fragile sites)
• Inner aspect of wrist
• Lower extremities, unless ordered by GP or necessary by pts condition
• Areas where valves are palpated or where veins bifurcate

Question 16

What are areas you absolutely want to avoid during IV insertion?

Answer 16

Below or above existing phlebotic or interstitial area

• on a limb w/an A-V fistula/graft
• Limb affected by a stroke
• on a mastectomy pt who have an a ill army dissection
• GP order is the only way an affected limb may be used, due to risk for lymphedema

Question 17

Why are larger veins more desirable for insertion?

Answer 17

Larger diameter veins have greater blood flow and can accept a large amount of fluid rapidly

• in shock states, superficial veins readily collapse, resulting in poor IV infusions

Question 18

What vein sites should be avoided as a general rule of thumb

Answer 18

Cord like, tortuous, scarred, or inflamed veins

Question 19

What skin sites as a general rule of thumb, be avoided

Answer 19

Avoid veins in infected, inflamed, or injured areas

Question 20

What is the Catheter selection dependent on?

Answer 20

Appropriate size of peripheral IV catheter followed by:

• purpose/duration of IV therapy
• Type of solution/med being administered
• Size and condition of pts veins
• Age and condition of patient

Question 21

What rule of thumb should be followed for Catheter selection?

Answer 21

1. Use the smallest gauge and the shortest length of catheter to achieve the desired therapy
2. Ensure that the vein used is larger than the catheter

Question 22

what is it important that the vein is larger than the catheter?

Answer 22

Ensures that blood flow around the catheter is sufficient to prevent vascular irritation from the catheter

• Ensures that there will be adequate hemodilution of the infusate
• Larger catheters will cause mechanical phlebitis sooner than smaller sizes

Question 23

How does gauge sizing work for catheters?

Answer 23

The larger the number, he smaller the needle/gauge?

Question 24

Slide 26, understand which gauge sizes are used for

Question 25

What are the benefits of using smaller gauge intravenous catheters over larger gauges?

Answer 25

More comfortable and cause less mechanical irritation than a larger gauge

Question 26

How many attempts does a practitioner have at inserting a IV?

Answer 26

After 2 unsuccessful attempts, another more experience and qualified individual must attempt the procedure - unsuccessful attempts must be documented on the IV flow sheet/patient care record - Date of insertion should be clearly transcribed at the IV site

Question 27

Insert slide 29

Question 28

What factors could enhance venous dilation and maximize the potential for a successful insertion:

Answer 28

1. Tourniquet use 2. Gravity 3. Fist Clenching 4. Tapping 5. Warm packs 6. Relaxation

Question 29

Tourniquet guidelines for use?

Answer 29

- Should be tied only tight enough to occlude venous circulation (not arterial circulation). - Place the tourniquet at least 4-6 inches above the intended IV site. - Should not be left on for extended period of time – always obser

Question 30

How to utilize gravity in a IV insertion?

Answer 30

Allow the limb to dangle below the heart level for a few minutes before insertion

Question 31

What needs to be kept in mind with fist clenching?

Answer 31

Remind the patient to relax their hand/arm prior to insertion of the IV catheter (if they don’t the vessel will occlude) - Open and close their fist for a few seconds with the tourniquet on (instruct)

Question 32

What needs to be kept in mind when tapping a vein?

Answer 32

**Gentle** tapping along the vein, not on. - flicking and slapping could bruise fragile veins

Question 33

Warm pack guidelines?

Answer 33

A warm towel is applied to the entire extremity and left in place no longer than 5-10 mins - remove once tourniquet is in place

Question 34

Relaxiation considerations before inserting IV? (insert slide 34)

Question 35

Cleaning guidelines for IV insertion?

Answer 35

1. Clean the site with chlorhexidine (2% CHG in 70% alcoho) 2. Apply cholrohexidine in a circular motion outward from insertion site from 2-4 inches ( as large as the dressing will be) 3. Use friction to scrub site in this circular fashion 4. Allow the chlorhexidine to dry 5. Do not repalpate the skin

Question 36

Catheter prepartion guidelines

Answer 36

- Remove IV catheter from package and inspect its integrity. - Hold the catheter hub by the tab. - Make sure catheter is secure. - Maintain sterility of catheter throughout

Question 37

Add slide 35

Question 38

Add slide 38 (stabilizes patient) - insert image on slide 40

Question 39

Before insertion of an IV, what should be ready?

Answer 39

Prepare IV and tubing or saline lock prior to insertion

Question 40

IV insertion technique and guidelines (slide 39-48)

Question 41

Slide 49 (documentation crap)

Question 42

What are potential causes of Hematoma formation due to IV insertion? (slide 50-51)

Question 43

Where ideally would you like to insert within the vein?

Answer 43

Top surface and fullest and most round area. - possible mistake would be to enter the side wall

Question 44

What are possible causes of missing a vein during insertion (2) (slide 52) - corrective action?

Question 45

What are possible causes if you’re unable to thread the catheter after entering/inserting the vein? (slide 53) - corrective action?

Question 46

We only go up to slide 54 (catheter feels flimsy upon insertion or advancement)