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LPN IV Series: Venipuncture and Maintenance

4 Contact Hours
This peer reviewed course is applicable for the following professions:
Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN)
This course will be updated or discontinued on or before Monday, December 5, 2022

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


This course is 1 of 8 courses available on CEUfast to meet the 24 hour written portion of the Florida LPN IV Certification requirement. The remaining 6 hours on the return demonstration of IV skills must be completed in person. To find a provider, or if you are interested in becoming a provider, refer to our Provider Information page.
Outcomes

Contact hours for LPNs in any state are earned by completing this course. This course is part of a series of 24 contact hours of courses to prepare for LPN IV Certification in Florida. Florida certification participants must schedule a 6-hour live presentation and return demonstration to complete IV Certification. CEUFast.com does not provide a live presentation.

Participants will be able to start and maintain IV therapy.

Objectives

After completing this continuing education course, the participant will be able to meet the following objectives:

  1. Correctly insert an IV catheter.
  2. Calculate flow rates.
  3. Maintain an IV site.
  4. Accurately assess an IV site.
  5. Respond to complications of IV therapy.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Authors:    Wesley Hunter (RN, PMT) , Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Introduction

The skin acts as a barrier between the outside environment and internal organs. When the barrier is broken, the risk for infection increases. An infusion access device perforates the skin, interrupts the integrity of the barrier, and increases the risk of infection. Any infection in this tissue can spread throughout the body. A strict aseptic technique for venipuncture care and site maintenance is necessary.

  • The vascular system is made up of blood vessels, including arteries, arterioles, capillaries, and veins. These vessels vary in size and function.
  • Arteries carry oxygenated blood away from the heart. The aorta is the largest artery emanating from the heart. Arteries branch off the aorta. As they branch off the aorta, they decrease in size and become arterioles. Arterioles subdivide into capillaries.
  • Capillaries provide nutrients to the tissue and take waste away. Capillaries connect with venules, which are the smallest veins. The venules connect with larger veins, eventually leading to the vena cava, which is the largest vein and connects directly to the heart.
  • Veins carry deoxygenated blood back to the heart. The deoxygenated venous blood is carried to the right atrium through the superior vena cava (SVC) and the inferior vena cava (IVC). The blood enters the right ventricle, exiting through the pulmonary artery to the lungs, where it is oxygenated and carried to the left atrium through the pulmonary veins.
  • The pulmonary artery carries deoxygenated blood, and the pulmonary veins carry oxygenated blood; these are the only exceptions to the rule that an artery contains oxygenated and a vein deoxygenated blood.

Heart Circulation

Heart Circulation

Inserting IV Catheter

Intravenous Therapy is an invasive procedure. Only veins are used for venipuncture. If blood pulses out of the catheter, you have hit an artery. Discontinue the catheter and hold pressure for 10 minutes.

ALERT
Aseptic technique should be used on all venipunctures, tubing changes, and dressing changes.

Before you begin the venipuncture, consider the following:

  • The purpose
  • Duration of use
  • Condition of veins
  • Type of infusion
  • Patients medical condition

When selecting a vein to perform venipuncture, consider the following factors:

  • Catheter size - Select a catheter with the shortest length and diameter that accommodates the provided therapy. A 20 gauge catheter can be used for blood transfusions if the patient cannot tolerate an 18. Smaller catheters lyse the RBCs during infusion, defeating the purpose.
  • Type of solution - Hypertonic solutions and various medications can irritate the vein. Consult with the pharmacy regarding the properties of the medications or solutions being delivered.
  • Alert: Do not administer continuous vesicant chemotherapy and parenteral nutrition exceeding 10% dextrose or 5% albumin in a peripheral line. A 20-gauge or larger catheter is needed in the forearm or above for IV contrast.
  • The vein condition - If the vein has recently been used or is bruised/red/swollen/red, then do not use.
  • Duration of therapy - Long-term therapy will require frequent venipunctures. When possible, alternate arms and always start distally.
  • Patient age –
    • Infants have fewer accessible sites than older children and adults.
    • In toddlers, the feet and hands are the most accessible sites.
    • The hands and the antecubital region offer the best sites for children, adolescents, teens, and adults.
    • The elderly may have very fragile veins, fragile valves, and a lack of connective tissue to stabilize the veins (rolling veins).
  • Patient preference - Use the non-dominant side whenever possible. Ask the patient if they have ever had an IV before and which site they prefer.
  • Patient activity - As much as possible, allow hands-free, especially if the patient uses a walker, crutches, or wheelchair.

Veins for Venipuncture

Veins for Venipuncture

Venipuncture Sites: Advantages vs Disadvantages
SiteAdvantagesDisadvantages
Back of Hand
  • Metacarpal veins
  • Easily accessible and visualized
  • Catheter lies flat on back of hand so easily stabilized
  • Allows successive IVs further up the arm if needed
  • Painful during insertion due to large number of nerve endings in hands
  • Phlebitis likely at site
  • Discomfort during movement if located near bend of wrist
  • Avoid digital veins
  • Use nondominant hand if possible
  • In the elderly or chronically ill, the veins on the back of the hand may look good, but may not be patent (sclerosed)
  • If you puncture a valve, the vein is likely to rupture (blow)
Forearm
  • Accessory cephalic vein - Along radial bone as a continuation of metacarpal veins of thumb
  • Cephalic vein - Along radial side of forearm
  • Larger veins
  • Allows rapid infusion
  • More tolerant of caustic substances
  • Can use large-gauge catheters
  • Does not impair mobility
  • Well supported by subcutaneous tissue
  • Danger of radial nerve injury
  • Discomfort during movement if located near bend of elbow
Inner wrist
  • Median antebrachial vein
  • Holds butterfly (winged) needles well
  • Can be used when no other means are available
  • Easily visualized
  • Very painful insertion due to nerve endings in the area
  • High risk of infiltration in this area
  • Possible nerve damage due to infiltration
Inner Elbow
  • Antecubital veins - In the antecubital fossa: median cephalic, median basilic, medial cubital)
  • Large veins
  • Allows rapid infusion
  • More tolerant of caustic substances
  • Can use large-gauge catheters
  • Used frequently for drawing blood
  • Visible or palpable in children when other veins will not dilate
  • Used in emergency situations
  • Can be used when no other means are available
  • Restricted elbow motion
  • Difficult to splint elbow
  • Infiltrates easily if the elbow moves a lot
  • May prevent successive IVs below lower on the arm
  • Veins may be sclerotic if blood has been drawn frequently from this site
Scalp VeinsUse only in infants
  • Easy to puncture an artery instead of a vein.
  • Difficult to stabilize catheter
Ankles and FeetToddlers only
  • Difficult to stabilize catheter
  • Easy for toddler to pull out
  • Do not use on anyone older than a toddler because of the increased risk of phlebitis, thrombosis, and infection

Central lines should be used (Nettina, 2019):

  • When infusions are:
    • Hypertonic
    • Highly irritating (chemotherapy, parenteral nutrition)
    • Required rapid or high-volume
  • When peripheral blood flow is diminished (shock, dehydration)
  • When peripheral veins are not accessible (obese, frequent venipuncture)
  • When hemodynamic monitoring is desired
  • When long term IV therapy is expected

Central lines will be discussed in another course.

IV Catheters

IV Catheters

Types of Catheters (Nettina, 2019)
CatheterPurposeMax flow rateVolume
  • 24 gauge
  • Color: Yellow or lime
  • Infants
  • Pediatrics
  • Elderly
  • Difficult venous access
23 mL/minSmall
  • 22 gauge
  • Color: Blue
  • Infants
  • Pediatrics
  • Elderly
  • Small veins
22-50 mL/minSmall
  • 20 gauge
  • Color: Pink
  • Adult
  • Most infusion types
55-80 mL/minMedium
  • 18 gauge
  • Color: Green

  • Fluid replacement
  • Blood Transfusion
  • Contrast-based radiographic tests
100-120 mL/minLarge
  • 16 gauge
  • Color: Gray
  • Rapid fluid replacement
  • Blood transfusion
150-240 mL/min

Large

  • 14 gauge
  • Color: Orange or brown
  • Rapid fluid replacement
  • Blood transfusion
250-300 mL/minExtra large
  • 18 gauge
  • Triple-lumen
  • Medial (blue)
  • Proximal (white)
  • Fluid replacement
  • Blood transfusion
  • Medication administration
26 mL/minLarge
  • 16 gauge
  • Triple-lumen
  • Distal (brown)
  • Fluid replacement
  • Blood transfusion
  • Medication administration
  • Hemodynamic monitoring
52 mL/minLarge

Butterfly (winged) metal needles are for short-term drug administration and should not be left in place. The needles easily cut the vein and lead to infiltration with the slightest movement.

Use only catheters the have a safety protection feature to guard against needlesticks.

Preparing Site

  1. If the site is dirty, clean the area with soap and water.
  2. Clean the IV site with a topical antiseptic according to your facility protocol.
    1. Betadine is often used. Some wipe the betadine off with alcohol
    2. Chlorhexidine is recommended. Alert: can burn or irritate the skin of infants under 2 months old
  3. Use the antiseptic in an outward, circular scrubbing. Clean from the center out. The gauze used on the outer side of the area is contaminated. If you use that gauze to go back to clean the center again, you have contaminated the site.
  4. Allow it to dry completely

Consider the patient's skin and allergies when picking the antiseptic.

Methods to destend a vein (Nettina, 2019)

  1. Apply a tourniquet at least 2-6 inches above the planned insertion site. Fasten the tourniquet with a slipknot or hemostat. A blood pressure cuff can be used as a tourniquet. The goal is to impede venous flow while allowing arterial flow. A looser tourniquet is effective in patients with fragile veins.
  2. Apply manual compression above the site by placing fingers on the vein. This procedure usually takes two people to do. The method is particularly effective in the elderly, diabetic, or chronically ill whose veins are fragile.
  3. Position the arm lower than the heart level while the patient opens and closes their fist, and you lightly stroke the vein downward.
  4. Lightly tap the vein. Be gentle, so the vein is not damaged.
  5. Apply warmth to the site using a dry, warm towel or heat pack.

Ultrasound-guided venipuncture improves efficiency and effectiveness (Nettina, 2019).

To reduce pain during venipuncture, penetrate these layers quickly.

Local anesthetic agents can be used to minimize pain. This include:

  • Topical vapor coolant sprays
  • Topical transdermal agents
  • Intradermal lidocaine
  • Pressure-accelerated lidocaine

The anesthetic decreases pain but may cause the vein to collapse (disappear) or cause an allergic reaction. A warm compress may decrease the vasoconstrictive effect of the local anesthetics.

The IV catheter and tubing should be secured to prevent dislodging and irritation at the catheter site. The facility usually determines the IV site dressing and stabilization device. A transparent semipermeable dressing and tape are often used. More reliable devices are made but may not be used by your facility. Be sure to tape the tubing to the skin several inches above the insertion site to prevent dislodging when manipulating the fluid bags or pumps.

Tubing

Use an aseptic technique when changing tubing and bags or bottles. The tubing systems have a spike on one end. Remove the protective cover from the bag or bottle and do not contaminate the insertion site. Remove the protective cover from the spiked end of the tubing and insert it into the bag or bottle. Setting up the system can be done in the medication room or at the patient's bedside. Most medication rooms have enough room to layout the equipment and control the sterile ends of the bags, bottles, and tubes.

Use only bags or bottles that are sealed and within the expiration date. If the contents of the bag or bottle of IV fluid are cloudy or not the color it is supposed to be, do not use it. The addition of medication or parenteral nutrition may change the color. These additions should be noted on the bag by the pharmacy or by the nurse who added the substance.

Microdrip systems deliver 60 drops/mL. It is used when infusing small volumes. It is commonly used with infants and pediatrics. Microdrips reduce the risk of clotting in the line because of the slow infusion rate. It also provides fluid overload safety by restricting the maximum amount infused. Microdrip systems may have a drip chamber that contains up to 100 mL and is clamped off from the liter bag of fluids. This restriction is an additional safety to prevent fluid overload in at-risk patients.

Macrodrip systems deliver 10, 15, or 20 drops/mL. 20 drops/mL is the most common type. Most facilities use a standard macrodrop size to prevent potential errors. Macrodrips are used in most adults for large quantity infusion and rapid infusion. Most IV bags and glass bottles have a built-in air vent to prevent a vacuum. If a glass bottle does not have a vent built-in, vented tubing can be used. Most facilities standardize their bags or bottles to avoid problems. Most facilities use bags.

Filters are usually built-in lines used for blood or parenteral nutrition. Some filters can be added between the tubing and the IV bag. Most facilities standardize to avoid problems. If you need a special filter for blood infusion, the blood bank will provide that add-in filter or special tubing with a built-in filter.

Most infusion pumps require special tubing. The facility will standardize this tubing.

Secondary administration tubing is used to piggyback IV medication bags to infusion tubing. The medication bag should always be hung higher than the IV liter bag.

There is specially coated tubing that prevents the leaching of polyvinyl chlorine from the tubing. This coated tubing should be used to infusion nitroglycerin, paclitaxel, and cyclosporine.

Tubing add-in devices are available. They include:

  • Single and multi-lumen extension sets
  • Extension loops
  • Needleless connectors
  • Inline filters
  • Manual flow-control devices
  • Stopcocks

Minimize tubing manipulation and multiple components in the tubing to reduce the chances of contamination.

The frequency of changing the IV administration sets is specific to facilities. The following are evidence-based recommendations for changing schedules.1 Primary and secondary continuous tubing should be changed no more frequently than every 96 hours and at least every 7 days. Tubing used for parenteral nutrition should be changed every 24 hours. Tubing used for blood must be changed every 4 hours. Tubing for fat emulsion infusion must be changed every 12 hours.

The tubing system must be labeled when it is hung with the date, the time it was opened, and the person's initials applying the tubing. This labeling allows everyone to identify when the tubing needs to be changed.

Flow Rates

The provider orders the flow rate (doctor, physician assistant, or nurse practitioner). The nurse and the pharmacist's role is to evaluate the order's appropriateness based on the patient's condition. The nurse's role is also to regulate and maintain the flow and monitor the total input.

The nurse should notify the provider if the rate does not seem to be the correct rate for the patient. Considerations include age, patient condition, patient tolerance of the infusion and the prescribed infusions.

The very young and elderly are easily fluid overloaded. The flow rate should be slower, or the patient must be carefully monitored.

The patient's condition will often determine the flow rate. Someone in hypovolemic shock requires a large amount of fluid. Someone with heart or renal failure requires restricted fluids.

Some medications cause vascular irritation (KCL, Phenergan) or have a potential allergic response (antibiotics). These medications should be more diluted or infused slowly.

Some medications' efficacy is based on the administration time and infusion speed (antibiotics). Some medications need to be titrated based on the patient's response (dopamine, nitroprusside, heparin).

The flow rate is controlled more easily and accurately with an infusion pump. A pump is the best practice. However, pumps are expensive; therefore, they may be a limited resource. Infusions not on a pump require more frequent monitoring of the flow rate. Flow control dials or clamps and occlusive clamps can slip or be dislodged. Another potential flow problem is stretching and distorting the tubing due to patient movement. Cold or viscous solutions can also cause flow fluctuations.

Calculating IV Infusion Rates

Infusion rates are usually ordered as volume (mL) per hour.

The flow rate is measured in mL/hours when using an infusion pump. To find the rate in mL/hour for an infusion pump, divide the total number of mL by the total number of hours (DHHS, 2015).

1000mL

8 hr = 125mL/hr (rate for an infusion pump)

When you regulate an IV flow rate with a clamp or dial controller, the rate will usually be measured in drips/minute. IV administration sets deliver a specific number of drops per mL. The number is on the package label. Standard drip sets deliver 10-20 drops/mL. Microdrip sets deliver 60 drops/mL and blood sets usually deliver 10 drops /mL. Dial controllers may not be accurate if the IV catheter is less than a 20 gauge.

Suggested formula for drips/minute (clamp or dial controller) (DHHS, 2015):

Total number of mL to infuse x drip factor (drops/mL)= flow rate (drops/minute)

Total number of minutes to infuse

Example: Administer 1000mL of D5W over 8 hours using an infusion set that delivers 10 drops/mL.

1000 mL x 10 drops/mL = ? drops/min

8 hours x 60 minutes

1000 mL x 10 drops/mL = ? drops/min

480 minutes

2.08 mL/minute x 10 drops/mL= ? drops/min

20.8 drops/mL (21 drops/mL, round to nearest whole number)

Maintaince

  • Flush the catheter with NS and aspirate blood prior to each infusion to assess catheter patency.
  • Flush the catheter with NS to clear the catheter lumen and prevent mixing with incompatible medicine.
  • Flushing with NS is as effective as flushing with heparin to maintain catheter patency.
  • Flush 10 mL NS to remove fibrin deposits, drug precipitate or other debris to ensure patency.
  • Locked catheters must be flushed before and after medication administration or solution.
  • Prefilled syringes are preferred for flushing rather than a nurse-filled syringe.
  • Use a push-pause method to inject the medication. Check the catheter for patency if resistance is met. Do not force.

Heparin is no longer routinely used to flush and maintain catheters. However, you may still hear the term hep lock. This term refers to a catheter with a short tube connected but not connected to a fluid bag or bottle. This hep lock allows the patient freedom when the IV infusions are intermittent.

Aseptic technique is used to access a hep-lock or IV tubing. Clean the hub of the hep-lock or tubing hub with alcohol. Do not contaminate the cleaned hub. Remove the protective cover from the injection device or tubing and connect it to the hub. Most systems have needless connecting injection devices and tubing. If not, tubing connected by a metal needle should be taped to the tubing to prevent accidental removal.

Assessment

Assess the IV catheter at least daily for signs of infiltration, infection, phlebitis, or other complications. The IV should be removed as soon as possible after treatment is completed. Also, remove if there are any signs of complications.

Complications (Nettina, 2019)

Infiltration is caused by dislodgement of the catheter from the vein with an unintentional infusion into the surrounding tissue.

Extravasation is the infiltration of vesicant solutions into the surrounding tissue. Vesicants include chemotherapy, hyperosmolar solutions, parenteral nutrition, and KCL.

Phlebitis is caused by:

  • Injury to the vein during venipuncture or prolonged catheter use
  • Catheter to large for the vein
  • Poor aseptic technique
  • Irritation to the vein because of rapid infusion or irritating solutions (smaller veins are more susceptible)
  • Clot formation at the end of the catheter due to slow infusion rates or inadequate hemodilution of infused medication or solutions
  • More commonly seen with synthetic polyurethane catheters than silicone catheters

Catheter-associated bloodstream infection is caused by:

  • Underlying thrombophlebitis
  • Contaminated equipment or solutions
  • Prolonged placement of the IV catheter, tubing or solution container
  • Lack of aseptic technique in insertion or dressing changes
  • Cross-contamination from other infected areas of the body
  • Critically ill or immunosuppressed

The infusion of excessive IV fluids causes fluid overload. The elderly, infants and patients with cardiac or renal failure are at greater risk.

Air emboli are caused by:

  • When air enters the catheter during tubing change or catheter removal of a central venous line (negative intrathoracic pressure sucks in the air during inspiration)
  • Air in tubing delivers by IV push or infusion

Occlusion or slow flow is caused by:

  • Malposition of the catheter against the side of a vein or valve
  • Clot at the end of the catheter
  • External mechanical causes (kinking of tubing, clogged filter, needless connector)

Hemorrhage is caused by:

  • Loose connections of tubing or injection port
  • Inadvertent removal of the catheter
  • Anticoagulation therapy

Venous Thrombosis is caused by:

  • Infusion of irritating solutions
  • Infection along catheter
  • Fibrin sheath formation around the catheter with eventual clot formation
  • Patient factors
    • Hypercoagulable state (cancer diabetes, end state renal failure)
    • History of deep vein thrombosis
    • surgical or trauma patients
    • Critical care patients
    • Extreme age
Complications
Infiltration
PreventionSignsIntervention
  • Select the best catheter and insertion site
  • Secure catheter and tubing
  • Splint site
  • Assess catheter for patency prior to use
  • Discomfort or pain
  • Swelling
  • Blanching
  • Coolness of surrounding tissue
  • Slows or quits flowing
  • Absence of blood backflow
  • Stop infusion
  • Disconnect tubing
  • Remove catheter
  • If severe, apply warm compress and elevate site
Vesicant Extravasation
PreventionSignsIntervention
Same as infiltration
  • Same as infiltration
  • Infusing a vesicant solution
  • Stop infusion
  • Disconnect tubing
  • Do not remove catheter
  • Apply dry cold compress
  • Contact provider
Phlebitis
PreventionSignsIntervention
  • Secure catheter and tubing
  • Splint site
  • Assess catheter for patency prior to use
  • Use large vein for irritating infusion
  • Adequately dilute irritating medications
  • Catheter-associated bloodstream infection
  • Discomfort and pain that will progress along the path of the catheter and vein
  • Redness, swelling, warmth, induration
  • Purulence
  • Red streak above site
  • Palpable venous cord
  • Apply warm compress
  • Elevate site
  • Consider removing the catheter
  • Consider pharmacological interventions (analgesic, anti-inflammatory, corticosteroids)
Catheter-associated bloodstream infection
PreventionSignsIntervention
  • Adhere to hand hygiene
  • Use aseptic technique
  • Clean site appropriately
  • Change tubing as recommended
  • Maintain integrity of the administration system
  • Use dressing that allows visualization of the site
  • Signs of local infection
  • Fever, chills
  • Nausea, vomiting
  • Elevated WBC
  • Malaise, tachycardia
  • Backache, headache
  • May progress to septic shock with profound hypotension
  • Stop infusion
  • Consider removing the catheter
  • Get a sample of any exudate for possible culture
  • When removing catheter, cut off the tip of with sterile scissors and place in sterile dry container for possible culture
  • Start appropriate antibiotic therapy
Circulatory overload
PreventionSignsIntervention
  • Assess for cardiac or kidney conditions
  • Be vigilant in high-risk patients
  • Monitor infusion rate
  • Use electronic infusion device in high-risk patients
  • Keep accurate intake and output
  • Splint the site if the flow rate fluctuates too widely with movement
  • Increased BP and pulse
  • Increased CVP, venous distention, engorged jugular veins
  • Headache
  • Anxiety
  • Shortness of breath,
  • Tachypnea, coughing
  • Pulmonary crackles
  • Chest pain
  • Notify the provider
  • Sit the patient up to ease breathing
  • Reduce IV infusion rate
  • Monitor for worsening condition
Air Embolism
PreventionSignsIntervention
  • Clear all air from tubing before infusion
  • Change solution containers before they run empty
  • Ensure all connections are secure
  • Use Luer-lock connections or administration sets with air-eliminating filters unless contraindicated
  • Use correct technique when removing central venous access devices
  • When removing central venous device, place the patient in supine or Trendelenburg, unless contraindicated so the insertion site is at or below the level of the heart
  • Instruct the patient to bear down (Valsalva maneuver) during catheter removal
  • Sudden onset of dyspnea, breathlessness and tachypnea
  • Chest pain, hypotension tachycardia
  • Altered mental status, altered speech
  • Change in facial appearance, paralysis
  • Immediately prevent additional air from entering the bloodstream by closing, kinking, clamping, or covering the existing device or insertion site with an air occlusive dressing
  • Immediately turn the patient on the left side and lower the head of the bed. This will trap air in the right side of the heart
  • Notify the provider immediately
  • Administer oxygen as needed
Occlusion or sluggish flow
PreventionSignsIntervention
  • Assess the functionality of the vascular access device routinely
  • Use appropriate flushing procedures
  • Secure the IV with tape and armboard if needed
  • Unable to withdraw blood or sluggish blood return
  • Sluggish flow or frequent occlusion alarms
  • Signs of infiltration or extravasation
  • Assess for mechanical causes of occlusion
  • Reposition the catheter by pulling back slightly on the cannula in case the cannula is against a wall or valve
  • Lower the solution container below the patient heart and observe for blood backflow
  • Assess the functionality of the electronic infusion device
  • Consider removing the device
Hemorrhage
PreventionSignsIntervention
  • Cap all central lines with Leur-lock adapters and connect Leur-lock tubing to the cap, not directly to the line
  • Secure catheters
  • Use a transparent dress if possible
  • Tape the remaining tubing in a loop so tension is not directly on the catheter
  • Keep pressure on sites where catheters for been removed
  • Anticoagulated patients must keep pressure for at least 10 minutes
  • Oozing or trickling of blood from insertion site or catheter
  • Hematoma
Apply direct pressure
Venous thrombosis
PreventionSignsIntervention
  • Select appropriate vascular access device and site location
  • Ensure proper dilution of irritating substances
  • Ensure proper placement of vascular access device
  • Institute nonpharmacological strategies for thrombosis prevention if possible (early mobility, adequate hydration)
  • Anticoagulant prophylaxis if ordered
  • Swelling and pain around the IV or in the extremity proximal to the insertion site
  • Slowing of IV infusion or inability to draw blood from the central line
  • Palpable lump in the cannulated vessel
  • Notify provider
  • Anticipate therapeutic anticoagulant dose

Removal

The peripheral IV catheter is removed when treatment is complete, or a complication requires removal. To remove a catheter:

  • Stop all fluids
  • While stabilizing the access device, lift the tape securing the device
  • Place a folded gauze over the insertion site
  • Apply pressure to the insertion site as you pull out the catheter
  • Hold pressure until the site stops bleeding
  • Apply a dressing per facility policy
  • Educate the patient to watch for bleeding and refrain from using that arm to lift heavy items for 30 minutes
  • Dispose of tubing and catheter per facility policy

Documentation

Documentation of IV therapy should include:

  • Date and time of insertion
  • Site and preparation of insertion
  • Number of attempts to start IV
  • Size and type of catheter inserted
  • Medications and solutions hung
  • Total intake of IV fluids
  • Date and time of removal
  • Management of complications

Patient Education

  • Plan of care and goal of treatment
  • Purpose of IV
  • Care of the IV devices and insertion site
  • Potential complications

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

  • Nettina, Sandra M., “The Lippincott Manual of Nursing Practice” 11th Ed. Wolter Kluwer, Philadelphia, 2019.
  • Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2011, December 1). Pub. 100-07 State Operations Provider Certification Summary of Changes: Clarification is provided for 42 CFR 482.23(c), concerning medication administration. Retrieved May 22, 2015, (Visit Source).