PRINCIPLES OF

INTRAVENOUS LINE ACESS

Peripheral venous line access
I.V line can be used for
Diagnostic purposes
Therapeutic purposes
Maintain patency of the

intravenous access
INDICATIONS OF I.V THREAPY
1.Replace fluids, electrolytes, calories,
nutrition
2.Fluid and electrolyte balance
3.Acid-base balance
4.provide fluid, electrolytes, calories or
nutrition to maintain homeostasis
5.transfuse blood and blood products
6.administer medications
 Vein selection
 Use distal veins of the arm first
 Use the client’s non dominant arm whenever possible
 Select a vein that is
Easily palpated and feels soft and full
Naturally splinted by bone
 Large enough to allow adequate
circulation around the catheter
 Avoid using veins that are
1. In areas of flexion
2. Highly visible, because they tend to roll away
from the needle
3. veins below a previous I.V. infiltration
4. veins below a phlebitic area
5. sclerosed or thrombosed veins
6. AREAS of skin inflammation, disease, bruising, or breakdown
7. An arm affected by a radical mastectomy, edema, blood clot, or
infection
8. An arm with an arteriovenous shunt or fistula. In a surgically
compromised or injured
Venipuncture site

 For adults, vein in the hand and arm are

commonly used
 For infants, veins n the scalp and dorsal
foot are often used
 Larger veins are preferred for infusions that
need to be given rapidly and for solutions
that could be irritating. (e.g., medications )
Muscle Man IV!
STARTING AN I.V.
1. Talk with patient/ concent
2. Gather equipment
3. Set up fluid and tubing on
pump
4. Wash your hands!!
5. Select a vein
6. Select a catheter size
8. Apply tourniquet 5-6 inches above insertion site
9. Never leave tourniquet on longer than one minute
10. Then Remove tourniquet and prepare equipment
STARTING AN IV (CONT.)
11. Cleanse skin with ANTSEPTIC SOLUTION
12. Allow to dry for 30 seconds
13. Put on gloves!!!!
STARTING AN IV (CONT.)
14.Immobilize vein
15.Position needle 10-15 degree angle over site
16. Insert cannula.
17. Watch for blood backflow
18.Advance cannula
19.Only try twice before calling for help
Advance cannula while holding stylet
stationary
Release tourniquet!!
 Stabilize the hub of the canula

22. Withdraw stylet while putting pressure on

vein above injection site
 Stabilize the hub of the canula
Apply pressure above while inserting the tubing
insertion site to slow
bleeding

Saline flush is already attached and

tubing flushed and ready

23. Insert tubing or prn adaptor

It may get messy sometimes, but with experience
this will be minimized
24. Flush with saline to clear tubing and insure IV has not infiltrated.
25. Stabilize tubing with tape to prevent IV from pulling out while
applying the sterile dressing.
27. Date, time and initial site and tubing
STARTING AN IV (CONT.)

28. Document!
COMPLICATIONS
PHLEBITIS
 Inflammation of the vein wall
—precursor to sepsis
 What causes phlebitis?

◦ IV left in too long

◦ Cannula too large
◦ Vein in poor condition
◦ Acidic solution or high osmolality
◦ Infusion rate too fast
INFILTRATION
 Leaking of nonvesicant fluid into
tissues surrounding the vein

 Check IV site every two hours

 Complications

◦ Nerve compression requiring

fasciotomy
INFILTRATION
EXTRAVASATION
 Administration of vesicant drug into
surrounding tissues
 Calcium
 Magnesium
 Phenergan
 Potassium chloride
 Antibiotics
 Chemotherapy drugs
 Vasopressors (Dopamine, epinephrine)
 Dextrose > 10%
 Lorazepam
INFECTION
 Cellulitis: An acute, spreading, bacterial
infection below the surface of the skin
characterized by redness (erythema), warmth,
swelling, and pain. Usually localized.
 Sepsis: clinical symptoms of systemic illness,

such as fever, chills, malaise, hypotension,

and mental status changes. Sepsis can be life
threatening.
Causes
 Poor insertion site

 Unsterile insertion
of I.V line

 IV left in too long—

change q 96 hours!

 Hub contamination
Cellulitis
Prevention
 Hand washing
 Sterile technique
 Proper Catheter size
 Proper Insertion site
 Site inspection every two hours
 Encourage patient to report any discomfort
Central venous catheter/line
Central venous catheter
 A central venous catheter is a catheter placed
into a large vein in the neck (
internal jugular vein or external jugular vein),
chest (subclavian vein) or groin (femoral vein).
IT IS USED FOR
 medication or fluids
 blood tests (specifically the "mixed venous
oxygen saturation"),
 cardiovascular measurements such as the
central venous pressure.
Indications
 Monitoring of the central venous pressure (CVP)
 Long-term Intravenous antibiotics
 Long-term Parenteral feeding
 Long-term pain medications
 Chemotherapy
 plasmapheresis
 Dialysis
 Frequent blood draws
 when Peripheral venous access is impossible
 persistent requirement for intravenous access
complications
 Mal-position of the CVP catheter
 Pneumothorax/hemothorax/hydrothorax
 Infection
 Air embolism
 hemorrhage
 arrhythmias
Venous cutdown
Venous cutdown

 Venous cutdown is an emergency procedure

in which the vein is exposed surgically and
then a cannula is inserted into the vein under
direct vision. It is used to get vascular access
in trauma and hypovolemic shock patients
when peripheral cannulation is difficult or
impossible. The saphenous vein is commonly
used, but antecubital and femoral vessels are
also suitable.
COMPLICATIONS
 Cellulitis
 hematoma
 Phlebitis
 perforation of the posterior wall of the vein
 venous thrombosis
 damage to the saphenous nerve
Patient’s Worst Nightmare!!!!
THANKS